What does this research mean for the field?

Hypertrophic cardiomyopathy increases the risk of bradyarrhythmia (HR 2.38) and permanent pacemaker implantation (HR 7.66) compared to controls. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to evaluate the association between hypertrophic cardiomyopathy (HCM) and risks of bradyarrhythmia and permanent pacemaker (PPM) implantation.

February 8, 2026

Hypertrophic cardiomyopathy increases the risks of bradyarrhythmia and pacemaker implantation: a nationwide cohort study

Key Result

Hypertrophic cardiomyopathy increased bradyarrhythmia risk (HR 2.38) and pacemaker implantation risk (HR 7.66) versus controls (p<0.0001).

Key Points

This study aims to evaluate the association between hypertrophic cardiomyopathy (HCM) and risks of bradyarrhythmia and permanent pacemaker (PPM) implantation.
Retrospective cohort study using National Health Insurance Research Database
Identified patients diagnosed with HCM from 2012 to 2017
Age- and gender-matched control cohort selected (1:1)
Primary outcomes included bradyarrhythmia; secondary outcomes included PPM implantation
Hazard ratios were assessed using a multivariate Cox proportional hazards model.
Higher percentage of sick sinus syndrome in HCM group (2.0%) compared to controls (0.5%) (p<0.001)
5.7% of HCM patients received PPM implantation compared to 0.6% in controls (p<0.001)
HCM was associated with increased risks of bradyarrhythmia (adjusted HR: 2.38, p<0.0001)
HCM significantly increased risk of PPM implantation (adjusted HR: 7.66, p<0.0001)
Atrial fibrillation (AF) increased risks of bradyarrhythmia (adjusted HR: 1.58, p<0.001) and PPM implantation (adjusted HR: 1.59, p<0.001).

Structured PICO

Does hypertrophic cardiomyopathy increase the risk of bradyarrhythmia and permanent pacemaker implantation compared to matched controls?

Population

15,670 patients (n=7,835 with hypertrophic cardiomyopathy and n=7,835 age- and gender-matched controls), mean age 63.8±14.5 years. Excluded prior bradyarrhythmia or permanent pacemaker implantation.

Intervention

Hypertrophic cardiomyopathy (HCM) diagnosis (exposure)

Comparator

Age- and gender-matched control cohort without HCM

Outcome

Bradyarrhythmiahard clinical

Hypertrophic cardiomyopathy is associated with a significantly increased risk of developing bradyarrhythmia and requiring permanent pacemaker implantation, particularly in those with concurrent atrial fibrillation or heart failure.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Previous studies have reported cases of bradyarrhythmia in patients with hypertrophic cardiomyopathy (HCM), raising suspicion of an increased risk of bradycardia in this population. However, the association between HCM and bradyarrhythmia, and the need for permanent pacemaker (PPM) implantation remains unclear. Purpose This study aims to assess the risks of bradyarrhythmia and PPM implantation in patients with HCM. Method This retrospective cohort study used the National Health Insurance Research Database to identify patients diagnosed with hypertrophic cardiomyopathy (HCM) from 2012 to 2017. Those with prior bradyarrhythmia or permanent pacemaker (PPM) implantation were excluded. An age- and gender-matched control cohort (1:1) was selected. Primary and secondary outcomes were bradyarrhythmia and PPM implantation, respectively. Hazard ratios were assessed using a multivariate Cox proportional hazards model. Result A total of 15,670 (n=7,835 in each group) patients with a mean age of 63.8±14.5 years were analyzed. During the follow-up period, the percentage of patients with sick sinus syndrome was higher in the HCM group (2.0%) than that in the control group (0.5%) (p0.001). The percentage of patients receiving PPM implantation was also higher in the HCM group (5.7%) than that in the controls (0.6%) (p0.001). HCM was associated with increased risks of bradyarrhythmia (adjusted HR: 2.38, p0.0001) and PPM implantation (adjusted HR: 7.66, p0.0001). In patients with HCM, the presence of atrial fibrillation (AF) was independently associated with increased risks of bradyarrhythmia (adjusted HR: 1.58, p0.001) and PPM implantation (adjusted HR: 1.59, p0.001). The presence of heart failure (HF) also increased the risk of PPM implantation (adjusted HR: 1.70, p0.001) in HCM patients. Conclusion Patients with HCM was associated with increased risks of bradyarrhythmia and PPM implantation. In patients with HCM, the presence AF and HF increased the risks of PPM implantation and should be closely monitored during their follow up.

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