Evidence that pharmacological strategies lack efficacy for the prevention of sudden death in hypertrophic cardiomyopathy

Objective: To determine the efficacy of pharmacological treatment in the prevention of sudden cardiac death in hypertrophic cardiomyopathy (HCM). Design: Clinical outcome was assessed retrospectively in 293 patients with HCM, including 173 who were taking cardioactive medications. Setting: Department of Cardiology, University of Padua, Padua, Italy; a tertiary HCM Centre. Interventions: Medical treatment with β blockers, verapamil, sotalol and amiodarone. Main outcome measure: HCM-related sudden cardiac death. Results: 17 of 173 (10%) patients died suddenly or had aborted cardiac arrest, while being treated continuously with drugs having antiarrhythmic properties, over a period of 62 (56) months. Sudden death occurred in 20% of patients administered amiodarone (6/30), 9% each of patients taking verapamil (4/46) or β blockers (7/76), and 0% of those taking sotalol (0/21). Patients taking cardioactive drugs (n = 173) and those without pharmaceutical therapy (n = 120) did not differ with respect to sudden death mortality. Conclusion: Medical treatment is not absolutely protective against the risk of sudden death in HCM. The present data inferentially support the use of the implantable defibrillator as the primary treatment choice for prevention of sudden death in high-risk patients with HCM.