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Implantable cardioverter defibrillators in the context of hypertrophic cardiomyopathy: a lesson in patient autonomy
  1. Jonathan James Hyett Bray1,2,
  2. Chiara Bucciarelli-Ducci1,
  3. Graham Stuart1
  1. 1Bristol Royal Infirmary, Bristol Heart Institute, Bristol, UK
  2. 2University of Bristol Academy, Bristol Royal Infirmary, Bristol, UK
  1. Correspondence to Jonathan James Hyett Bray, Jonathan.Bray{at}


Hypertrophiccardiomyopathy (HCM) is common, whereas the decision not to have an implantable cardioverterdefibrillator (ICD) when probably falling into a ‘high-risk’ category is not. A solicitor aged 45 years attended the inherited cardiac conditions clinic for review of her HCM and discussion about ICD implantation for primary prevention of sudden cardiac death (SCD). Despite a predicted 7% risk of SCD within the next 5 years, according to the European Society of Cardiology endorsed HCM Risk-SCD risk stratification tool, the patient opted against implantation of an ICD and comprehensively justifies her decision. This report discusses ethical aspects of a consultation offering ICD protection against SCD in the context of HCM and emphasises the clinicians’ role in respecting patient autonomy.

  • ethics
  • cardiovascular medicine

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  • Contributors JJHB is responsible for writing the manuscript, obtaining consent and reviewing the literature surrounding the case. CBD provided help with figure acquisition. GS is the Consultant Cardiologist who consulted the patient about the decision of whether to have an ICD or not, was responsible for conceptualising the case report and thoroughly reviewed the introductory and background literature. All authors edited and reviewed the manuscript, and have approved the final version.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.