HCM

HCM AFIB ANTICOAGULATION

       -In regards to anticoagulation, Under normal circumstances, we would
    utilize the CHADS2-VASc scoring system for risk of thromboembolic
        events.  However, in those studies, HCM patients were not included (in
        most of those studies) and thus is not be clinically applicable
  -There have been several studies linking the increased risk of
    Afib and CVA with HCM (Olivotto I et al.  "Impact of atrial
    fibrillation on the clinical course of hypertrophic
    cardiomyopathy." Circulation. 2001;104(21):2517.)
            -This is reflected in the 2014 AHA / ACC Afib guidelines in that
    the anticoagulation should be given for HCM patients
    independent of CHADS2-VASc score (Class I indication)

HCM - AFIB AAD 

        -In regards to AAD, the 2014 AHA / ACC AFib guidelines give Amiodarone 

         or Disopyramide (in conjuncture with an AVN Blocking Agent) to prevent 

         recurrent afib in patients with HCM (January, Craig et al.  "2014 AHA / 

         ACC / HRS Guideline for the management of patients with atrial 

         fibrillation." Circulation. 2014;130:e199-e267)

HCM - ICD INDICATIONS

As per the 2024 AHA Guidelines on the Management of Hypertrophic Cardiomyopathy,

the patient qualifies for an ICD if they have:

     -H/o SCD, VF or sustained VT --> Class I

     -If they have 1 of the following, then it is a Class IIa

             (a) Family History of SCD.  FHx of SCD is defined as:

                     "Sudden death judged definitely or likely attributable

                         to HCM in >  1 first degree or close relatives who are

                         <  50 years of age.  Close relatives would generally be

                         second degree relatives;  however, multiple SCDs in

                         tertiary relatives should also be considered"

             (b) Massive LVH > 30 mm in any segment

             (c) Unexplained syncope as defined as:

                     "> 1 unexplained episodes involving acute transient loss

                         of consciousness;  judged by history unlikely to be of

                         neurocardiogenic (vasovagal) etiology, nor attributable

                         to LVOTO, and especially when occuring within 6 months

                         of evaluation (events beyond 5 years in the past do not

                         appear to have relevance)

             (d) Apical Aneurysm

             (d) EF < 50%

     -If they have NSVT (with greater weight if runs are frequent ie > 3 and

         longer > 10 beats and faster > 200 bpm) --> it is only a 2B if patient

         is agreeable (shared decision making)

     -If they have extensive LGE on CMR as defined as > 15% of LV mass, it is

         only a 2B if patient is agreeable (shared decision making)

For reference, these guidelines are from Ommen, Steve et al.  "2024

AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic

Cardiomyopathy: A Report of the American Heart Association/American College of

Cardiology Joint Committee on Clinical Practice Guidelines" Circulation Vol 149,

no 23