Abstract
.The analysis of the data retrieved from defibrillators and implantable pacemakers in patients with HCM demonstrates that the mechanism of sudden death is ventricular tachycardia, followed by ventricular fibrillation 4 . Cardiac structural changes resulting from HCM such as cellular disorganization (misaligned myocytes), fibrosis and cell death are the most probable causes of arrhythmias. There is not an isolated test identifying with a reasonable degree of accuracy those patients at risk of sudden death, which makes stratification complex and imprecise. A study in patients with HCM who underwent routine 24-hour Holter 5 showed that 90% of patients had ventricular arrhythmias, and more than 20% had ventricular extrasystoles higher than 200/24h; more than 40% had paired ventricular extrasystoles; and perhaps the most important finding in the study, 20% to 30% of patients had non-sustained ventricular tachycardia. This high prevalence of ventricular arrhythmias on Holter is certainly disproportionate to the relatively low incidence of sudden death in patients with HCM 2
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