Nonsustained ventricular tachycardia (NSVT), defined as ≥3 consecutive ventricular beats at ≥120 beats/min lasting <30 seconds, is an independent predictor of sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HC). Current guidelines recommend 24- to 48-hour Holter monitoring as part of SCD risk stratification. We sought to assess the difference in diagnostic yield of 14-day Holter monitoring compared to 24-48 hours for the detection of NSVT and to assess the prevalence and characteristics of NSVT in patients with HC with prolonged monitoring. We retrospectively analyzed the 14-day Holter monitors of 77 patients with HC from May 2014 to March 2016. Number of episodes and maximal length and rate on each day were recorded. NSVT was detected in 75.3% of patients during 14-day Holter monitoring. The median number of runs was 2 (range 0 to 26 runs). The median number of beats of the longest run was 10.5 (range 3 to 68 beats) with a mean maximum rate of 159.5 ± 20.8.4 beats/min (range 102 to 203 beats/min). First episodes of NSVT were detected throughout the 14 days, with only 22.5% and 44.8% of the episodes captured within the first 24 and 48 hours of monitoring, respectively. In conclusion, prolonged Holter monitoring revealed ≥1 episode of NSVT in 75% of patients with HC of which <50% were detected within the first 48 hours. Hence, prolonged Holter monitoring may be superior for SCD risk stratification in HC. However, the high prevalence of NSVT in this population may limit its utility in evaluating the risk for SCD of the individual patient.
Copyright © 2016 Elsevier Inc. All rights reserved.