Effect of Cardiac Resynchronization on Gradient Reduction in Patients with Obstructive Hypertrophic Cardiomyopathy: Preliminary Study

Abstract

These preliminary data suggest that CRT seems to be an effective method of reducing the outflow tract gradient and improving the functional status of symptomatic HOCM patients requiring ICD implantation. Our findings need to be confirmed by more extensive studies.

Novel trigenic CACNA1C/DES/MYPN mutations in a family of hypertrophic cardiomyopathy with early repolarization and short QT syndrome

“…The CRT was not considered as the standard therapy for HCM patients [2], but there are some reports on the effectiveness of resynchronization therapy on reducing the outflow tract gradients in HCM patients [34–36]. Although the mechanism is not clear yet, some proposes that the biventricular pacing changed the sequence of the ventricular excitation, which helps to reduce the outflow tract gradient and to reverse the remodeling of the left ventricles [35]. Our report adds clinical support to the effectiveness of the CRT on reducing the outflow tract gradients, which might be a promising strategy for the treatment of HCM patients.…”

Implantable Defibrillators in Long QT Syndrome, Brugada Syndrome, Hypertrophic Cardiomyopathy, and Arrhythmogenic Right Ventricular Cardiomyopathy

“…57 Small observational trials have shown some improvement in patients with HCM with cardiac resynchronization by decreasing LVOT gradient, affecting LV electrical activation, decreasing outflow tract gradient, and leading to positive remodeling. [76][77][78] Cardiac resynchronization therapy thus may be considered in patients with left bundle branch block in the setting of worsening LV dysfunction. There are limited data on the subcutaneous defibrillator in patients with HCM.…”

Potential Role of Biventricular Pacing Beyond Advanced Systolic Heart Failure

“…14,40 A preliminary study of 11 patients revealed that CRT significantly reduced the outflow tract gradient (22 mmHg), and improved both NYHA class and exercise capability at 6-month follow-up. 14 The effect persisted and the outflow gradient was further reduced at 3-year follow- considerable technical challenges in implantation because of the significant anatomic abnormalities with the condition's highly heterogeneous etiology, technological innovations have facilitated the application of CRT even in complex CHD. 45 The main phenotypes of HF in CHD include systemic LV failure, systemic RV failure and failure of a single ventricle.…”

“…10 However, it is becoming clear that CRT not only benefits such patients but potentially could be expanded to include a wider patient population. Most recently, some researchers have provided evidence to expand the application of CRT to include patients with mild HF, 11 patients who require pacing with normal LV function, 12 upgrading CRT from right ventricular (RV) pacing only, 13 in special cardiomyopathies such as hypertrophic obstructive cardiomyopathy (HOCM) 14 and noncompaction of ventricular myocardium, 15 as well as in patients with congenital heart disease (CHD) who require cardiac pacing therapy. 16 In this review article, we summarize the potential role of CRT in patients beyond those with severe HF based on CRT Beyond Severe HF LV global and regional performance, as well as LV remodeling, by synchronizing mechanical dyssynchrony.…”