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Left ventricular hypertrophy and arrhythmia

INTRODUCTION

Data, primarily from the Framingham Heart Study, have identified electrocardiographic left ventricular hypertrophy (LVH) as a blood pressure-independent risk for sudden cardiac death (SCD) [1,2], acute myocardial infarction [3], and other cardiovascular morbidity and mortality [4]. (See "Clinical implications and treatment of left ventricular hypertrophy in hypertension" and "Electrocardiographic diagnosis of left ventricular hypertrophy".)

These relationships can be illustrated by the following findings in patients with a definite electrocardiographic pattern of LVH:

  • A 59 percent overall mortality at 12 years [2]
  • A threefold increase in the risk of developing overt coronary heart disease at 14 years, even after adjustments for concomitant hypertension are made [3]
  • A sixfold increase in sudden cardiac death among men and a threefold increase in women [3]
  • A 10-fold increase in congestive heart failure at 16 years [4]

Echocardiographic studies, which more reliably document the presence of LVH, have confirmed and expanded the above observations [5-7]. For each 50 g/m2 increase in left ventricular mass, the relative risk of death from cardiovascular disease is 1.73 in men and 2.12 in women. The echocardiogram has also established other important features of LVH, particularly an eccentric or concentric pattern [7].

This topic will review the evidence linking hypertension and LVH to ventricular arrhythmia and sudden cardiac death. The pathogenesis of LVH in hypertension is discussed separately. (See "Definition and pathogenesis of left ventricular hypertrophy in hypertension".)

                 

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Literature review current through: Aug 2014. | This topic last updated: Feb 14, 2013.
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