EHRA 2023 — Dr Juan Caro Codón (La Paz University Hospital, Madrid, ES) discusses the findings from the TEMPO-HCM study investigating extended ECG monitoring in hypertrophic cardiomyopathy (HCM) patients.
This was a prospective, observational, multicenter trial that included patients with a diagnosis of hypertrophic cardiomyopathy. Investigators compared the rate of clinically relevant arrhythmias within 30 days vs their first 24 hours with an ECG.
What is the significance of this study and what are the barriers in treating HCM patients?
Study design, patient cohort, and outcome measures?
Current findings of the study?
How should these findings influence practice and guidelines?
What are the next steps?
Filmed on-site at EHRA 2023, Barcelona.
Editor: Jordan Rance
“- Good morning. My name is Juan Caro Codón. I’m a consultant from Hospital Universitario La Paz and we are going to discuss extended ECG monitoring in patients with hypertrophic cardiomyopathy.
Importance of the Study
Well, the TEMPO-HCM study is in fact a call for new research regarding extended ECG in this group of patients because what we have learned from this study is that non-sustained VTs are absolutely prevalent among these population and this raises questions regarding its true ability to discriminate high risk from low-risk patients regarding sudden cardiac death. And we also think that it’s very important because there is a signal here that perhaps is an useful technique to screen for atrial fibrillation in these patients.
Study Design, Patient Cohort and Outcome Measures
We are conducting a prospective observational multicenter registry including patients with diagnosis of hypertrophic cardiomyopathy and we aim for a low-risk score. So we are excluding patients with an already implanted ICD and what we do is to use a dedicated device for ECG monitoring for 30 days and we compare the rate of clinically relevant arrhythmias during 30 days versus the first 24 hours. And what we have found is that the detected incidence of significant arrhythmias is much higher with extended ECG monitoring than with 24 hours monitoring.
Findings to Date
The findings is that there are absolutely more arrhythmias using extended ECG monitoring, and that difference was highly significant, and it was mainly driven by the certainly high prevalence of non-sustained VTs in the low-risk patients with hypertrophic cardiomyopathy during extended ECG monitoring.
Influence of Findings on Practice and Guidelines
I think that we should start considering extended ECG monitoring in patients with hypertrophic cardiomyopathy in order to adequately screen for atrial fibrillation and that we should be very careful when some patients show us in their device some episode of non-sustained VT, we should be very careful to adopt clinical With that information, we should encourage research in this area.
The next obvious steps are to include more patients in our registry. We are trying to aim for a large cohort and we are expecting to continue the follow-up and to report clinical outcomes from these patients, which I think, they will be very, very interesting.”