Impact of Right Atrial-Left Ventricular Dual-Chamber Permanent Pacing in Patients With Severely Symptomatic Hypertrophic Obstructive Cardiomyopathy

Abstract

Background Effective alternatives to surgical myectomy for patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) remain unestablished. Dual-chamber (DDD) pacing was evaluated in these patients using right atrial (RA) and epicardial left ventricular (LV) leads. Methods and ResultsIn 6 patients with HOCM refractory to medical therapy and conventional RA-right ventricular (RV) DDD pacing, we implanted DDD pacemakers using RA and epicardial LV leads. The baseline intraventricular pressure gradient before pacemaker implantation was 103±44 mmHg. The pressure gradient decreased significantly to 8±16 mmHg by temporary RA-LV DDD pacing (p=0.006), while it decreased only to 68±25 mmHg by temporary RA-RV pacing (NS). It was nearly eliminated to 1±2 mmHg (p=0.027) 3 months after RA-LV DDD pacemaker implantation. LV end-diastolic pressure, cardiac index and systolic aortic pressure did not change significantly. New York Heart Association class improved in all patients (p=0.023). Brain and atrial natriuretic peptide concentrations, respectively 516±286 and 143±34 pg/ml at baseline, decreased significantly to 230±151 and 93±44 pg/ml 3 months after implantation (p=0.027 and 0.028). Conclusion RA-LV DDD pacemaker implantation is a useful option for patients with symptomatic HOCM. (Circ J 2005; 69: 536 -542)

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

“…Results of right atrial‐left ventricular pacing in six patients with HOCM have been recently presented by Honda et al 17 The authors found that epicardial pacing with electrodes surgically placed near the left ventricular apex reduced the outflow tract gradient and improved patients’ functional status after 3 months of pacing. Berruezo et al have recently demonstrated in their preliminary report that biventricular pacing (as opposed to left or right ventricular stimulation) was an optimal pacing mode in the majority of HOCM subjects 18 .…”

“…The hypothesis of a pacing‐induced change in the direction of electrical activation of the LV has been postulated over 15 years ago to explain the potential benefit exerted by DDD pacing in HOCM subjects 7–8 . This change of activation and contraction sequence was supposed to result in the paradoxical movement of the septum with subsequent disappearance of systolic anterior mitral motion and thus broadening of the left ventricular outflow tract during systole 17 . Nevertheless, despite encouraging preliminary results, several randomized studies failed to confirm the beneficial effect of DDD stimulation in HOCM patients 9–10 .…”

Age-Related Hemodynamic and Morphologic Differences in Patients Undergoing Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

“…For symptomatic patients with a fixed or inducible obstruction who are intolerant or unresponsive to medical treatment, surgical myectomy or dual-chamber pacing is recommended. [1][2][3] One decade ago, Ulrich Sigwart introduced alcohol septal ablation (ASA) as an alternative therapy for symptomatic HCM patients with obstruction (HOCM). 4 The hemodynamic and clinical benefits of ASA have been clearly demonstrated in many studies to date.…”

Dynamic Left Ventricular Outflow Tract Obstruction Post–Transcatheter Aortic Valve Replacement

“…Although we do not view the evidence for pacing in the HOCM population with LVOTO to be conclusive ( 6 ), we deemed this the safest and least invasive next step in this patient. He was scheduled for biventricular pacemaker insertion, as there is some evidence that this approach is superior to right ventricular pacing alone ( 7 ). We failed to achieve an adequate position for the coronary sinus lead, and a dual-chamber system was implanted instead.…”