Comparison of Acute Reduction in Left Ventricular Outflow Tract Pressure Gradient in Obstructive Hypertrophic Cardiomyopathy by Disopyramide Versus Pilsicainide Versus Cibenzoline

Kajimoto, Katsuya; Imai, Taku; Minami, Yuichiro; Kasanuki, Hiroshi

doi:10.1016/j.amjcard.2010.06.059

Cited by 26 publications

(13 citation statements)

References 27 publications

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“…3,5-7,11,14 We Disopyramide's particular efficacy in obstructive HCM is due to its marked negative inotropic effect compared with other agents, 23,24 and that it has no vasodilator effect. 25 In direct head-to-head comparisons of its effect on gradient, it is more potent than verapamil or β-blockade.…”

Section: Disopyramidementioning

confidence: 99%

“…25 In direct head-to-head comparisons of its effect on gradient, it is more potent than verapamil or β-blockade. 24 It is usually given in combination with β-blockade to blunt the exercise-related rise in gradient, for synergistic negative inotropic effect, and to provide AV delay, if atrial fibrillation occurs. Despite its type I antiarrhythmic effects, proarrhythmia with disopyramide is very rare in patients with HCM; we found a very low rate of sudden death mortality (0.1%/y).…”

Section: Disopyramidementioning

confidence: 99%

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Treatment of Obstructive Hypertrophic Cardiomyopathy Symptoms and Gradient Resistant to First-Line Therapy With β-Blockade or Verapamil

Sherrid

Shetty

Winson

et al. 2013

Circ: Heart Failure

122

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Echocardiograms with standard imaging planes were performed at initial evaluation and last follow-up. Continuous wave Doppler was used to measure LVOT gradient from the apical 5-and 3-chamber views to record maximum velocity parallel to the systolic LVOT flow. Care was taken to separate LVOT signal from that of mitral regurgitation. Gradient was measured during 3 Valsalva maneuvers and after standing. The simplified Bernoulli equation was used to calculate gradient. After 1994, capable patients underwent treadmill testing with Bruce protocol and had gradients acquired after exercise.

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Section: Disopyramidementioning

confidence: 99%

Section: Disopyramidementioning

confidence: 99%

Treatment of Obstructive Hypertrophic Cardiomyopathy Symptoms and Gradient Resistant to First-Line Therapy With β-Blockade or Verapamil

Sherrid

Shetty

Winson

et al. 2013

Circ: Heart Failure

122

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“…One study demonstrated that disopyramide significantly reduced resting LVOT gradient to a greater extent versus propranolol (p<0.01) . Another study found that disopyramide significantly reduced resting LVOT gradient by 58.6 ± 15.0% compared with 7.7 ± 9.9% with verapamil and 19.0 ± 20.2% with propranolol (p<0.001 for both analyses) …”

Section: Pharmacodynamics Of Disopyramide In Hcmmentioning

confidence: 98%

Disopyramide for Hypertrophic Cardiomyopathy: A Pragmatic Reappraisal of an Old Drug

Verlinden

Coons

2015

Pharmacotherapy

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Hypertrophic cardiomyopathy (HCM) is a genetic cardiac disorder characterized by unexplained left ventricular hypertrophy in the absence of other cardiac or systemic etiologies. Approximately two-thirds of patients with HCM develop left ventricular outflow tract (LVOT) obstruction with or without provocation, whereas nearly half develop heart failure with preserved ejection fraction. Medical management of heart failure with preserved ejection fraction is based on the presence of symptoms and LVOT obstruction and frequently includes β-blockers or verapamil. Disopyramide is a class Ia antiarrhythmic that historically was used for the treatment of arrhythmias; however, its contemporary use is often reserved for patients with HCM who are persistently symptomatic despite β-blockers or verapamil and have evidence of LVOT obstruction. The pharmacologic rationale for use of disopyramide is largely based on its strong negative inotropic property. Three clinical studies have showed significant improvements in heart failure symptoms and a reduction in the need for invasive therapy in patients treated with disopyramide. Appropriate dosing and monitoring of disopyramide are important to mitigate the potential for anticholinergic adverse events and proarrhythmias. Disopyramide is a safe and effective medication that reduces heart failure symptoms and LVOT gradient and delays the need for invasive therapy in patients with obstructive HCM.

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“…Given that the efficacy of cibenzoline for reducing the LV pressure gradient in HOCM was equivalent to that of disopyramide and pilsicainide, other class Ia antiarrhythmic drugs could be equally effective at treating intraventricular obstruction arising after TAVI. 4 To our knowledge, this is the first reported case of a patient in whom intraventricular obstruction appeared after TAVI was treated with addition of a class Ia antiarrhythmic drug. Given that patients who undergo TAVI have comorbidities and high risk for invasive therapy, this strategy can be a useful option to relieve intraventricular obstruction and patient's symptoms.…”

Section: Isobe Et Al Midventricular Obstruction After Tavimentioning

confidence: 99%

Effective Cibenzoline Treatment in a Patient With Midventricular Obstruction After Transcatheter Aortic Valve Implantation

Isobe

Ieda

Kohno³

et al. 2016

Circ: Heart Failure

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A n 80-year-old woman with severe aortic stenosis was admitted to our hospital for transcatheter aortic valve implantation (TAVI). She had New York Heart Association functional class III congestive heart failure. Her comorbidities included multiple myeloma, idiopathic thrombocytopenic purpura treated with chronic steroids, hypertension, diabetes mellitus, and persistent atrial fibrillation. Echocardiography demonstrated a calcified tricuspid aortic valve with leaflet restriction consistent with severe aortic stenosis ( Figure 1A; Movie I in the Data Supplement). The instantaneous peak velocity across the aortic valve on Doppler imaging was 5.0 m/s, and the mean pressure gradient was 53 mm Hg ( Figure 1B). The aortic valve area calculated by using the continuity equation was 0.49 cm 2 . A concentric left ventricular (LV) hypertrophy was observed in the septum, measuring 13 mm, and in the posterior wall, measuring 14 mm. The LV cavity was small, with an LV internal dimension of 39 mm at end diastole. LV ejection fraction was 80%. Late peaking of the midcavitary LV pressure gradient of 25 mm Hg at rest was observed, without LV outflow tract obstruction and systolic anterior motion of the mitral valve leaflet ( Figure 1C). Coronary angiography revealed no significant coronary artery stenosis. Given her severe aortic stenosis and heart failure symptoms with comorbidities of severe thrombocytopenia (platelet count: 15 000 per μL), the patient underwent TAVI via the transfemoral approach. A 23-mm Sapien valve (Edwards Lifesciences, Irvine, CA) was successfully implanted. The hemodynamic profile of the patient throughout and after the procedure was stable. Her symptoms improved, and she was discharged and prescribed with a β-blocker, vasodilators, and diuretics as outpatient treatments.Two months later, she was admitted to our hospital for recurrent exertional dyspnea. Her physical examination revealed jugular venous distension, bilateral legs edema, and a 3 of 6 systolic ejection murmur at the lower left sternal border.Electrocardiography showed atrial fibrillation with bradycardia (heart rate: 30-50 beats per minute). Given her conditions of heart failure with volume overload and bradycardia, intravenous furosemide was administered and the dose of the β-blocker was reduced. However, her symptoms worsened with hypotension and renal dysfunction. Echocardiography revealed that the Edwards Sapien valve prosthesis was functioning properly with minimal paravalvular regurgitation. LV systolic function was hyperdynamic, and significant midventricular obstruction was observed with concentric LV hypertrophy during systole, with a peak pressure gradient of 69 mm Hg at rest (Figure 2A and 2B). No significant LV outflow tract obstruction and systolic anterior motion of the mitral valve were observed. Given the above-mentioned findings, the patient's deterioration was attributed to hypertrophic obstructive cardiomyopathic physiology with the development of midventricular obstruction after the removal of the LV pressure overload. Th...

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Comparison of Acute Reduction in Left Ventricular Outflow Tract Pressure Gradient in Obstructive Hypertrophic Cardiomyopathy by Disopyramide Versus Pilsicainide Versus Cibenzoline

Cited by 26 publications

References 27 publications

Treatment of Obstructive Hypertrophic Cardiomyopathy Symptoms and Gradient Resistant to First-Line Therapy With β-Blockade or Verapamil

Treatment of Obstructive Hypertrophic Cardiomyopathy Symptoms and Gradient Resistant to First-Line Therapy With β-Blockade or Verapamil

Disopyramide for Hypertrophic Cardiomyopathy: A Pragmatic Reappraisal of an Old Drug

Effective Cibenzoline Treatment in a Patient With Midventricular Obstruction After Transcatheter Aortic Valve Implantation

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