The Author's Response: Additional Description for Sudden Cardiac Death Risk Factors of the Apical Hypertrophic Cardiomyopathy Patient Who Underwent Stereotactic Cardiac Radiation

摘要

The authors also agree with Dr. Payus and Dr. Mustafa's opinion that prognostic factors for the patient should be described in detail because a small number of patients with apical hypertrophic cardiomyopathy progress to a fatal clinical outcome.1 The patient was referred to our hospital at the age of 72 years for work-up of abnormal surface electrographic findings, which was incidentally found during a health care examination in the local clinic. The patient had no prior history of syncope or family history of sudden cardiac death at the time of diagnosis. One year after diagnosis, three years prior to cardiac radioablation, the patient experienced unexplained syncope immediately followed by out-of-hospital cardiac arrest with documented ventricular tachycardia/fibrillation and a defibrillator was implanted. However, the patient did not complain of chest pain or heart failure symptoms (New York Heart Association functional class I) following diagnosis through the defibrillator implantation to the cardiac radioablation. Although the patient began to complain of mild chest discomfort and dyspnoea around the radioablation, it was not clear whether the patient's symptoms were caused by recurrent ventricular arrhythmia events, or acute/post-traumatic stress disorder, or radiation-induced mild pulmonary fibrosis. Generally, from the diagnosis to the start of radioablation, the patient's heart failure symptoms were minimal if arrhythmic events were absent, and diuretic agents were not prescribed in the outpatient clinic. We could not perform a gene study or counselling for the patient's family members due to the patient's refusal. The patient did not have other comorbid diseases. We describe additional clinical information which was not previously described in the manuscript due to word count limitations. We believe that clinicians should keep in mind the risk of sudden arrhythmic .