Abstract 327: Basic Life Support and Defibrillation Are Changing the Prognosis of Hypertrophic Cardiomyopathy in School Students

Abstract

OBJECTIVES: Hypertrophic cardiomyopathy (HCM) has been one of the leading causes of sudden cardiac death in school students. However, recent spread of basic life support combined with public access defibrillation and implantable cardioverter-defibrillator (ICD) has a possibility of a paradigm shift for prognosis of HCM in young. METHODS: In Japan, more than 98% of all students in primary, middle, and high schools subscribe in the mutual aid system, and a school that experienced event relating sudden death is obliged to submit all health checking documents to refund for the affected student. Submitted reports were investigated for 8 years between 2004 and 2011. All victims or survivors diagnosed as HCM were extracted from those reports. Demographic data, presence of diagnosis before event, and intensity of physical activity at event were compared between them. RESULTS: Though data in 2011 is still tentative, annual numbers of victims with HCM from 2004 to 2011 were 4, 4, 5, 6, 3, 2, 4, 1, respectively. The first resuscitated survivor with HCM was reported in 2007, thereafter from 2008 until 2011, those were 6, 2, 4, 2, respectively. Therefore, totals of 29 victims and 15 survivors were enrolled in this study. All survivors were middle or high school students. Three primary school students were all victims. The male-to-female ratio was 4.8 and 2.0, respectively (NS). Ratio of students who were previously diagnosed as HCM was 48% and 20%, respectively (p=0.06). Concerning exercise intensity at cardiac event, 24% and 6.7% were occurred without exercise, respectively (p=0.08). ICD insertion after successful resuscitation was reported in 80% of survivors. CONCLUSIONS: Induction of basic life support and defibrillator has a certain impact for increasing survivors with HCM in school students. After 2008, survivors become equal or more than victims. Majority of survivors were disclosed by initial cardiac event by strenuous exercise, and cardioverter-defibrillator was implanted after resuscitation. Strategy for survival of HCM students with previously diagnosed should be reviewed. School caregivers including general physicians should acquire the management of students with ICD.