Abstract 4373072: Evaluating the Outcomes and Complications of Implantable Cardioverter Defibrillator Therapy in Hypertrophic Cardiomyopathy

Abstract

Background: Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, ICD implantation is associated with risks, including inappropriate therapy, lead failure, and pocket bleeding, which may impact patient outcomes. Research Question: What are the incidence rates of complications and outcomes associated with ICD implantation in HCM patients? Objective: To quantify the annualized incidence rates of ICD-related complications and clinical outcomes, including appropriate interventions, inappropriate therapy, mortality, and device-related adverse events, in HCM patients. Methods: This PRISMA-compliant systematic review and meta-analysis included 30 studies from PubMed and ScienceDirect, reporting outcomes and complications post-ICD implantation in HCM patients. Data on ICD interventions, mortality, and device-related complications were extracted. Pooled annualized incidence rates were calculated using random- and fixed-effects models. Results: The meta-analysis included 5,618 HCM patients with ICDs. The annualized rate of appropriate ICD interventions was 4.00%. All-cause mortality was 1.30% per year, with cardiac and non-cardiac mortality each at 0.60% per year. Inappropriate therapy occurred at 3.80% per year. Device-related complications included lead malfunction (1.40%), lead displacement (1.10%), infection (0.70%), pocket bleeding (0.60%), cardiac tamponade (0.20%), deep vein thrombosis (0.30%), and pneumothorax (0.10%) per year. Heart transplant occurred at 0.80% per year. Conclusions: ICDs in HCM patients demonstrate a favorable annualized appropriate intervention rate of 4.00% and low mortality rates. However, moderate rates of inappropriate therapy and device-related complications highlight the need for careful patient selection to optimize the risk-benefit profile. Further studies are needed to refine ICD indications and reduce complications in HCM populations.