Functional assessment of patients treated with permanent dual chamber pacing as a primary treatment for hypertrophic cardiomyopathy

McDonald, Ken; McWilliams, Eric; O'Keeffe, B; Maurer, B.

doi:10.1093/oxfordjournals.eurheartj.a062584

Cited by 130 publications

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“…[1][2][3] Despite advances in our understanding of its pathogenesis and diagnosis, the progressive nature of hypertrophic cardiomyopathy has not been remedied. Pharmacologic agents (beta-blockers, calcium-channel blockers, and disopyramide), 4 dual-chamber pacing, [5][6][7] and surgical myomectomy have all been used to treat hypertrophic cardiomyopathy. Both pacemaker implantation and surgical myomectomy provide hemodynamic and clinical benefits in patients with drug-resistant hypertrophic cardiomyopathy.…”

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confidence: 99%

Nonsurgical Reduction of the Interventricular Septum in Patients with Hypertrophic Cardiomyopathy

et al. 2002

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Nonsurgical Reduction of the Interventricular Septum in Patients with Hypertrophic Cardiomyopathy

et al. 2002

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“…[11][12][13][14][15] Whereas several early observational and uncontrolled studies have suggested that atrial-synchronous ventricular pacing may importantly reduce outflow gradient and symptoms, [11][12][13][14][15] other more recent investigations have yielded less uniform and more mixed results, including some skepticism. 16 -20 The present randomized controlled trial was undertaken to resolve the uncertainties surrounding the utility and efficacy of DDD pacing in patients with obstructive HCM.…”

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confidence: 99%

Assessment of Permanent Dual-Chamber Pacing as a Treatment for Drug-Refractory Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy

Maron

Nishimura²,

McKenna³

et al. 1999

Circulation

438

249

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for the M-PATHY Study Investigators* Background-Dual-chamber pacing (DDD) has been proposed as a treatment alternative to surgery for severely symptomatic patients with obstructive hypertrophic cardiomyopathy (HCM), based largely on uncontrolled studies. Methods and Results-This prospective, multicenter trial assessed pacing in 48 symptomatic HCM patients with Ն50 mm Hg basal gradient, refractory to drug therapy. Patients were randomized to 3 months each of DDD pacing and pacing backup (AAI-30) in a double-blind, crossover study design, followed by an uncontrolled and unblinded 6-month pacing trial. With randomization, no significant differences were evident between pacing and no pacing for subjective or objective measures of symptoms or exercise capacity, including NYHA functional class, quality of life score, treadmill exercise time or peak oxygen consumption. After 6 additional months of unblinded pacing, functional class and quality of life score were improved compared with baseline (PϽ0.01), but peak oxygen consumption was unchanged. Outflow gradient decreased 40%, 82Ϯ32 mm Hg to 48Ϯ32 mm Hg (PϽ0.001), and was reduced in 57% of patients but showed no change or an increase in 43%. At 12 months, 6 individual patients (12%) showed improved functional capacity; each was 65 to 75 years of age. Left ventricular wall thicknesses in the overall study group showed no remodeling between baseline (22Ϯ5 mm) and 12 months (21Ϯ5 mm; PϭNS). Conclusions-(1)Pacing cannot be regarded as a primary treatment for obstructive HCM; (2) with randomization, perceived symptomatic improvement was most consistent with a substantial placebo effect; (3) longer, uncontrolled pacing periods were associated with some subjective benefit but unaccompanied by objective improvement in cardiovascular performance and should be interpreted cautiously; (4) modest reduction in outflow gradient was achieved in most patients; and (5) a small subset (12%) Ն 65 years of age showed a clinical response, suggesting that DDD pacing could be a therapeutic option for some elderly patients. (Circulation. 1999;99:2927-2933.)

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“…4 Since then, DDD pacing in drug-refractory HOCM has been reported to improve exercise tolerance and the LVOT pressure gradient. [5][6][7] These findings have been considered a consequence of reduced or paradoxical movement of the interventricular septum derived from RV pacing. 7,10 There is, however, no method to predict the efficacy of chronic DDD pacing before pacemaker implantation.…”

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Dual-Chamber Pacing in Hypertrophic Obstructive Cardiomyopathy

et al. 1999

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anagement of patients with drug-refractory, symptomatic hypertrophic obstructive cardiomyopathy (HOCM) is a challenging problem. Septal myotomy/myectomy and mitral valve replacement have been performed for 3 decades, but these surgical treatments carry significant mortality, and the postoperative prognoses are not always favorable. Anticoagulation must be continued permanently after mitral valve replacement, and symptomatic deterioration and aortic regurgitation have been reported in patients after myotomy/myectomy. [1][2][3] Recently, atrioventricular (AV) sequential pacing with a short AV delay has been proposed as a therapeutic method for patients with drug-refractory HOCM, 4 and some investigators have reported favorable results from therapeutic dual-chamber (DDD) pacemaker implantation. 5-7 However, the guidelines for the indication of pacemaker implantation in these patients have not been established yet. The purpose of the present study was to evaluate whether the chronic effects of DDD pacing with a short AV delay can be predicted from the temporary AV sequential pacing in

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Functional assessment of patients treated with permanent dual chamber pacing as a primary treatment for hypertrophic cardiomyopathy

Abstract: Patients with severe hypertrophic cardiomyopathy pose a difficult management problem. Between 1984 and 1986, 11 such patients have been treated by dual chamber pacing. (DDD). Subjectively all patients improved and objectively there was an increase in exercise tolerance during paced rhythm.

Cited by 130 publications

References 0 publications

Nonsurgical Reduction of the Interventricular Septum in Patients with Hypertrophic Cardiomyopathy

Nonsurgical Reduction of the Interventricular Septum in Patients with Hypertrophic Cardiomyopathy

Assessment of Permanent Dual-Chamber Pacing as a Treatment for Drug-Refractory Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy

Dual-Chamber Pacing in Hypertrophic Obstructive Cardiomyopathy

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