Analyzing Trends in Implantation of Cardiac Electronic Devices in Obstructive Hypertrophic Cardiomyopathy

A study found an overall decline in surgical myectomy (SM) with implantable cardioverter defibrillator (ICD) procedures, according to a study that was presented at AHA 2024.

“Septal reduction therapy (SRT) options for (oHCM) include surgical myectomy (SM) and alcohol septal ablation (ASA). A significant proportion of these SRTs also concurrently receive an (ICD),” the researchers noted.

In this National Inpatient Sample study, researchers queried 420 cases to identify adults with oHCM using appropriate ICD codes and procedure codes were obtained for SM with ICD placement and ASA with ICD placement respectively. They used logistic regression models to compare in-hospital outcomes.

The proportion of annual SM with ICD placement rates continued to decrease from 2016 and 2021 (Table 1). In comparison to this, there was an increase in ASA with ICD placement rates each year. During the study period, a majority of ASA with ICD occurred in the northeast while the majority of SM with ICD occurred in the midwest. More than 90% of SRTs were performed at large urban teaching centers. ASA with ICD cases had a higher proportion of SRT complications including development of complete heart block (62.2% -vs- 41.7%, p<0.001) but lower incidence of ventricular fibrillation (2.7% -vs-9.5%, p=0.003). ASA with ICD cases had a shorter length of stay (6.6 -vs- 10.9 days) and less total hospitalization cost ($240,792 -vs- $314,359). For both groups, major complications were uncommon and remained unchanged throughout this study period.

The findings were “indicative of an overall decline in SM with ICD procedures from 2016 to 2021. Further analysis is needed to understand the impact of this trend on long term outcomes of oHCM patients.”

Reference

Desai S, Roma N, Pattoli M, et al. Temporal Trends in Implantation of Cardiac Electronic Devices Following Septal Reduction Therapy in Obstructive Hypertrophic Cardiomyopathy. Abstract #Mo2104. Presented at the American Heart Association Scientific Sessions 2024; November 16-18, Chicago, Illinois.