The April case scenario will review metric 47, proportion of CRT-D patients that fulfill class 2A guideline recommendations. A 51-year-old African-American male was admitted for loss of consciousness lasting less than two minutes on March 18th, 2024, with no CPR required. His medical history includes hyperlipidemia, hypertension, and longstanding history of hypertrophic cardiomyopathy. His hypertrophic cardiomyopathy has been well controlled with medications until recently. For the past two weeks, he's experienced increased shortness of breath, palpitations, and chest pain. However, he did not seek medical evaluation. He is the head coach for a college basketball team and his increased symptoms occurred during the same time as March Madness 2024. His college basketball team just won round 32 and was well positioned for the Sweet 16 round. His initial evaluation revealed a New York Heart Association classification of two to three, a left bundle branch block, and a QRS duration of 130 milliseconds on an ECG, 33 millimeters of myocardial muscle wall thickness, and an LVEF of 40 to 45% on echo. An electrophysiology study revealed sustained ventricular tachycardia and a CRT device implant followed. The question we have for you is, is this patient included in the numerator for metric 27? Number one, no. Or number two, yes. Take a moment to select the answer from the available options. The correct answer is no. This patient does not meet the numerator criteria for metric 27 for proportion of CRTD initial implants that fulfill a class one, class 2A, or class 2B guideline recommendation. To meet the numerator for metric 27, the patient scenario must meet the criteria for both an ICD, the defibrillating portion, and a CRT, resynchronization portion, to meet the DBT guideline recommendation. All patient scenarios must have an EF less than 35% to meet the resynchronization portion of the device per the 2008 ACC, AHA, HRS guidelines and 2012 ACCF, AHA, HRS focused update guidelines. To recap, a 51 year old African American male was admitted for loss of consciousness on March 18th, 2024 with no CPR initiated. His medical history includes hyperlipidemia, hypertension, and longstanding history of hypertrophic cardiomyopathy. His hypertrophic cardiomyopathy has been well controlled with medications until recently. For the past two weeks, he has experienced increased shortness of breath, palpitations, and chest pain. However, he did not seek medical evaluation and this all occurred during a March Madness 2024. His college basketball team just won round 32 and was well positioned for the Sweet 16 round. His initial evaluation revealed a New York Heart Association classification of two to three, a left bundle branch block, and a QRS duration of 130 milliseconds on ECG, 33 millimeters of myocardial muscle wall thickness, and an LVEF of 40 to 45% on echo. An electrophysiology study revealed sustained ventricular tachycardia and a CRTD device implant followed. Now, is this patient included in the numerator of metric 47 proportion of CRTD patients that fulfill class 2A guideline indications for hypertrophic cardiomyopathy and left bundle branch block? Number one, no. And number two, yes. Please take a moment to determine the best selection for the question. The correct answer is yes. This patient meets the numerator of metric 47 with a 2A guideline recommendation. Per the 2020 AHA ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy, this patient scenario meets a class 2A guideline recommendation. Let's review the document for the specific recommendation. Per the 2020 AHA ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy, patients with non-obstructive hypertrophic cardiomyopathy receive an ICD who have NYHA class 2 to ambulatory class 4 heart failure, left bundle branch block, and left ejection fraction of less than 50%. Cardiac resynchronization therapy for symptoms reduction is reasonable. Thank you for viewing the EP device implant registries April 2024 case scenario.

hypertrophic cardiomyopathy

CRT-D device implant

ventricular tachycardia

left bundle branch block

cardiac device implantation guidelines