Ventricular arrhythmias and sudden cardiac death – Epidemiology, prognosis, outcome 209 Survival analysis with most cases occurring in middle-aged male athletes with a better prognosis than SCA during other activities. P1014 Risk stratification scores for sudden cardiac death in hypertrophic cardiomyopathy: is volume better than diameter? F. Montenegro Sa, C. Ruivo, J. Correia, J. Morais. Hospital Santo Andre, Cardiology, Leiria, Portugal. On behalf of Portuguese registry of Hypertrophic Cardiomyopathy investigators Introduction: To stratify sudden cardiac death (SCD) risk in hypertrophic car- diomyopathy (HCM) patients, the HCM risk-SCD prediction model is currently recommended. However, it includes a 2D evaluation of a three dimensional struc- ture, the left atrium diameter (LAd). In different pathologies, the left atrium volume index (LAVi) has shown better prognosis prediction ability. Aim: To determine if LAVi is a SCD predictor, and to compare if a SCD risk score that includes LAVi evaluation is better than the currently used HCM risk-SCD prediction model. Methods: We analyzed a national European-based registry including 879 adult patients with phenotype positive HCM that underwent evaluation between 1975 and 2015. Only patients with all HCM risk-SCD score needed variables and echocardiographic LAVi determination were selected. Mean follow-up was 65±75 months. The demographic, clinical and laboratorial data, past medical history, electro and echocardiographic data, cardiac magnetic resonance information, treatment and mortality details were registered. A Cox regression model was used to determine SCD predictors and integrated in a mathematical score (score 2). Also, the HCM risk-SCD prediction model was applied in the same population. To compare both models, a pairwise comparison of ROC curves was used. Results: We included a total of 179 patients, with mean age 52±16 years and 40.2% (n=72) females. SCD occurred in 3.85% (n=12) cases. Mean LAVi was 45±19 mL/m 2 . Score 2 included 3 variables: LAVi ≥72 mL/m 2 (OR=26.50, 95CI 3.95–177.37, p value<0.001), presence of ≥1 classical risk factor (syncope, extreme left ventricular hypertrophy, family history of SCD, presence of non- sustained ventricular tachycardia or abnormal blood pressure response during exercise – OR = 4.66, 95CI 1.59–13.70, p value = 0.005) and age at diagno- sis <55 years (OR=1.67, 95CI 1.35–5.00, p value=0.011). This prediction model presents an area under the curve (AUC) of 0,953. ROC curve comparison be- tween HCM risk-SCD and score 2 is presented in picture 1. Picture 1. Pairwise ROC comparison Conclusions: Left atrial volume index in HCM patients is a SCD predictor. How- ever, the HCM risk-SCD model showed a prediction ability that was at least non- inferior to the LAVi based score. Current recommendation of using the HCM risk- SCD is still the best validated score for the European HCM population. P1015 Atrial fibrillation and the risk of sudden cardiac death in patients with hypertrophic cardiomyopathy - a nationwide cohort study using insurance claims database T.T.L. Lin 1 , J.J.J. Juang 2 , C.K.W. Wu 2 , M.T.L. Liao 1 , C.C.W. Wu 1 , L.Y.L. Lin 2 . 1 National Taiwan University Hospital Hsin-Chu Branch, Internal Medicine, Hsinchu, Taiwan ROC; 2 National Taiwan University Hospital, Department of Internal Medicine, Division of Cardiology, Taipei, Taiwan ROC Background: Hypertrophic cardiomyopathy (HCM), affecting 0.2% of the popula- tion, is the leading cause of sudden cardiac death (SCD). Incident atrial fibrillation (AF) is associated with an increased risk of SCD general population. It is unknown whether AF is associated with an increased risk of SCD in patients with HCM. Methods: We identified patients from a nation-wide database called Registry for Catastrophic Illness, which encompassed almost 100% of the patients with HCM in Taiwan from 1995 to 2013. Among 10910 participants, mean age was 62 years and 47.5% was female. The main outcome was physician-adjudicated SCD, de- fined as death from a sudden, pulseless condition presumed due to a ventricular tachyarrhythmia. The secondary outcome was non-SCD (NSCD): coronary heart disease death not meeting SCD criteria. We used Cox proportional hazards mod- els to assess the association between AF and SCD/NSCD, adjusting for baseline demographic and cardiovascular risk factors. Results: There were 1169 AF, 371 SCD and 797 NSCD events occurred during follow-up (median, 8.5 years). The crude incidence rates of SCD were 12.45/1000 person-years (with AF) and 3.57/1000 person-years (without AF). The crude in- cidence rates for NSCD were 31.29/1000 person-years (with AF) and 6.63/1000 person-years (without AF). The multivariable hazard ratios (HRs) (95% CI) of AF for SCD and NSCD were 3.633 (2.756–4.791) and 2.086 (1.799–2.418), respec- tively. Risk of sudden cardiac death and non-sudden cardiac death by atrial fibrillation status Total Without AF With AF Sudden cardiac death Number of events, N (%) 371 (3.4) 205 (2.1) 166 (14.2) Person-year 70185 57323 13327 Crude incidence rate (95% CI) a 5.286 3.576 12.455 (4.768–5.845) (3.111–4.092) (10.672–14.461) Hazard ratio (95% CI) b 1 3.633 (2.756–4.791) Nonsudden cardiac death Number of events, N (%) 797 (7.3) 380 (3.9) 417 (35.6) Person-year 70185 57323 13327 Crude incidence rate (95% CI) a 11.365 6.629 31.291 (10.597–12.164) (5.987–7.322) (28.396–34.412) Hazard ratio (95% CI) b 1 2.086 (1.799–2.418) a Per 1000 person-years of follow-up, 95% CI was estimated by Mid-P exact test. b Cox pro- portional hazards model adjusted for age, sex, comorbidities (hypertension, diabetes, hyperlipi- demia, chronic kidney disease, coronary heart disease, heart failure, stroke) and medications. Figure 1 Conclusions: Incident AF is associated with an increased risk of SCD and NSCD in the HCM population. Additional research to add AF to HCM-SCD risk model is warranted. P1016 Ventricular arrhythmias in athletes and non-athletes: diagnostic role of electroanatomic mapping and CARTO-guided endomyocardial biopsy G. La Rosa, M.L. Narducci, G. Pelargonio, M. Bianco, A. Almohani, G. Bencardino, F. Perna, F. Inzani, V. Novelli, R. Marano, F. Spera, G. Pinnacchio, V. Palmieri, P. Zeppilli, F. Crea. Catholic University of the Sacred Heart, Department of Cardiovascular Medicine, Rome, Italy Background: Life-threatening ventricular tachyarrhythmias (VAs) represent the first cause of sudden cardiac death in young athletes, and previous report demon- strated the presence of active myocarditis or arrhythmogenic right ventricular cardiomyopathy (AVRC) in athletes studied by 3D-electroanatomic mapping (3D- EAM). It is unknown if there are differences in electroanatomic substrate in young athletes and non-athletes with VAs as first clinical presentation. Aims: To characterize the electrophysiological substrate of VAs as first clinical presentation in athletes and non-athletes patients (pts), using cardiac magnetic resonance imaging (cMRI), 3D-EAM and endomyocardial biopsy. To evaluate the Downloaded from https://academic.oup.com/eurheartj/article/39/suppl_1/ehy564.P1016/5080787 by guest on 10 February 2022