Hypertrophic cardiomyopathy in a young athlete at risk for sudden cardiac death

A 15 year-old patient with hypertrophic cardiomyopathy (HCM) was evaluated in electrophysiology clinic for consideration of an implantable cardioverter defibrillator (ICD). Given his risk factors for sudden cardiac death, an ICD was recommended. The next decision was whether a transvenous or subcutaneous ICD would be best option. Following a meticulous screening process and subsequent implantation, formal exercise testing with interrogation of the patient’s device vectors during exercise was performed. This guided selection of his primary vector as the sensing channel to ensure appropriate device therapy for malignant ventricular arrhythmias while reducing his risk for inappropriate shocks. In follow-up, the patient was successfully treated for an episode of ventricular fibrillation, but had been able to exercise without sustaining any inappropriate shocks.