Recurrent ICD Discharges in a Patient with Obstructive Hypertrophic Cardiomyopathy and High Gradients

A 41-year-old female with a history of hypertrophic obstructive cardiomyopathy, who had an ICD implanted for the primary prevention of sudden cardiac death, presents after recurrent appropriate shocks from her device for ventricular tachycardia and ventricular fibrillation which has been refractory to antiarrhythmic medications. Observational studies have shown that LV outflow tract gradient reduction is associated with a decreased incidence of appropriate ICD discharges in patients with obstructive hypertrophic cardiomyopathy. This patient ultimately underwent gradient reduction surgery with septal myectomy and has been free of ventricular arrhythmias in the post-operative period.