Dr. Rachel J. Lampert, MD, a cardiac electrophysiologist and professor of medicine at Yale School of Medicine, and patient advocate Hannah Keime of HeartCharged join Dr. John Fritzlen to discuss arrhythmias, sudden cardiac death, and life after receiving an implantable cardioverter-defibrillator (ICD) in hypertrophic cardiomyopathy (HCM). The conversation covers how often patients with HCM receive ICDs and device therapy, why shock risk persists for a decade or more after implant, and how clinicians look for precipitants and structural changes before escalating treatment with beta blockers, antiarrhythmics like sotalol, catheter ablation, or cardiac denervation. Dr. Lampert shares findings from the LIVE-HCM study on vigorous exercise and arrhythmia risk, along with a structured approach for safely returning to exercise after a shock. Additionally, Hannah reflects on being shocked both in her sleep and on stage, the emotional weight of living with a device, and how adjustments to her ICD programming shaped her experience.

Patient advocates Hannah and Bethany Keime from HeartCharged sit down with Dr. John Fritzlen to discuss the long-term journey of living with hypertrophic cardiomyopathy (HCM). The conversation covers the progressive nature of the condition, including the onset of heart failure symptoms, atrial fibrillation, and myocardial remodeling over decades, as well as how advanced diagnostics like cardiopulmonary exercise testing (CPET) help clinicians track subtle declines. Dr. Fritzlen shares tailored approaches for counseling young or newly diagnosed patients, emphasizing the importance of active lifestyle management and proactive treatment strategies like cardiac myosin inhibitors. Additionally, the group addresses the critical clinical and lifestyle factors involved in selecting implantable cardioverter-defibrillators (ICDs), detailing the durability advantages of subcutaneous (S-ICD) and extravascular (EV-ICD) systems for active, younger populations.

Dr. Florian Rader joins Dr. Louise Bjerregaard to discuss a groundbreaking randomized, double-blind, triple-crossover trial that challenges the long-standing "mantra" of using beta blockers as first-line therapy for non-obstructive hypertrophic cardiomyopathy (HCM). Dr. Bjerregaard explains how the study compared bisoprolol, verapamil, and placebo, revealing that bisoprolol actually resulted in a significant reduction in functional capacity and a worsening of patient symptoms as measured by the KCCQ score. The conversation explores why slowing the heart rate may be detrimental to patients with "stiff hearts" who rely on chronotropic competence to maintain cardiac output, and why calcium channel blockers like verapamil might be a more favorable alternative for symptom management. This episode is essential listening for clinicians looking to move beyond expert opinion toward evidence-based, personalized care for their non-obstructive HCM patients.

View the results of the trial here: https://www.jacc.org/doi/10.1016/j.jacc.2025.11.028