Extended ECG Monitoring in Patients with Hypertrophic Cardiomyopathy: The Tempo-HCM Study

Abstract

Highlights: What’s known? Thromboembolic events and SCD are two well-established complications of HCM linked, respectively, to atrial and ventricular arrhythmias. Clinical practice guidelines recommend monitoring using periodic 24–48 h Holter to aid clinicians in decisions regarding oral anticoagulation to prevent thromboembolic events and ICD placement for SCD prevention. Extended electrocardiographic monitoring well beyond 24–48 h has proven valuable in different clinical scenarios but has not been studied in patients with HCM. What’s new? Extended ECG monitoring significantly enhances the detection of relevant arrhythmias in patients with HCM. NSVT are detected in most low-risk HCM patients using this technique. Further research is needed before routinely including findings from extended monitoring in the risk stratification process for SCD, as this strategy may compromise HCM-SCD calculator specificity. Extended monitoring might improve AF screening in HCM. Background/Objectives: Current guidelines recommend 24–48 h Holter for risk stratification and atrial fibrillation (AF) screening in hypertrophic cardiomyopathy (HCM). However, the limited duration of this approach may not provide optimal sensitivity. In addition, extended ECG monitoring has been demonstrated to be more effective in detecting arrhythmias in other clinical entities. We aimed to assess the utility of extended ECG monitoring for 30 days in a non-high-risk cohort of HCM patients. Methods: We conducted a prospective multicentre study with 113 non-high-risk HCM patients who underwent 30-day ECG monitoring with a dedicated device. We compared the detection of relevant arrhythmias (AF, atrial flutter, and non-sustained ventricular tachycardia) during 30-day monitoring with the findings observed during the first 24 h. Results: Extended ECG monitoring detected relevant arrhythmias in 63.7% of patients, compared with 12.4% during the first 24 h (p < 0.001). This difference was mainly driven by non-sustained ventricular tachycardia (NSVT) (61.1% vs. 8.9%, p < 0.001). Atrial fibrillation episodes were detected in 10.6% of patients after completing prolonged monitoring vs. 6.2% during the first 24 h (p = 0.066). Extended monitoring resulted in a reclassification of 21.2% of patients to a higher sudden cardiac death (SCD) risk category using the HCM-SCD calculator. Conclusions: Extended ECG monitoring significantly enhances the detection of arrhythmias in HCM. Using this technique, NSVT were detected in most patients of a non-high-risk HCM cohort. Further investigation is warranted to determine the role of extended monitoring in SCD risk stratification and AF screening.