Pacing for drug-refractory or drug-intolerant hypertrophic cardiomyopathy

Qintar, Mohammed; Morad, Abdulrahman; Alhawasli, Hazem; Shorbaji, Khaled; Firwana, Belal; Essali, Adib; Kadro, Waleed

doi:10.1002/14651858.cd008523.pub2

Cited by 25 publications

(11 citation statements)

References 204 publications

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“…It thus seems justifiable to propose that short AV delay pacing should again be considered as a reasonable first-line option for patients who are less than ideal candidates for myectomy and with significant remaining gradient/and or symptoms on medical therapy. As suggested by Qintar et al 20 commenting upon a Cochrane review, further larger randomized trials of short AV delay pacing are justified.…”

Section: Discussionmentioning

confidence: 98%

Short atrioventricular delay pacing therapy in young and old patients with hypertrophic obstructive cardiomyopathy: good long-term results and a low need for reinterventions

et al. 2017

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AimsExamination of long-term results following different treatments in hypertrophic obstructive cardiomyopathy (HOCM) in a complete geographical cohort.Methods and resultsHOCM patients attending during 2002–13 in all 10 hospitals in the West Götaland Region, Sweden, were identified (n = 251), follow-up 14.4 (±8.9) years (mean ± SD), 121 managed medically, 42 treated with myectomy and 88 with short atrioventricular (AV) delay pacing as first interventional procedure. Post-intervention follow-up was 12.9 ± 8.7 years and 12.2 ± 5.0 years, respectively. Both intervention treatments improved New York Heart Association (NYHA) class and outflow gradients significantly. Patients treated with pacing were older (median age 64 vs. 43 years, P < 0.001). Freedom from disease-related death post-procedure at 5, 10, and 20 years were 93%, 80%, 56% vs. 93%, 93%, 57% in pacing and myectomy groups, respectively (log-rank P = 0.43). Survival after diagnosis was not different in patients just treated conservatively (P = 0.51 pacing/conservative; P = 0.39 myectomy/conservative). Reintervention for outflow gradients in patients ≥18 years at procedure occurred in 3.5% in pacing group and 15.6% in myectomy group (P = 0.007). Pacing therapy was equally effective in patients aged 13–64 years (n = 44), as in patients ≥65 years (n = 44): resting gradient pre-procedure and at last follow-up were median (IQR) 65 (71) and 12 (20) mmHg for <65 year-olds (P < 0.001), and 75 (64) and 14 (38) mmHg, respectively, for ≥65 year-olds (P < 0.001). New York Heart Association class improved significantly in both age ranges to 1.6 ± 0.6 and 1.8 ± 0.7, respectively (P < 0.001; P < 0.001).ConclusionShort AV delay pacing provided lasting satisfactory relief of symptoms and outflow obstruction in the majority of patients, with low risk of requiring reintervention. Our findings support the view that pacing therapy should be considered a valid option to treat patients with HOCM.

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Section: Discussionmentioning

confidence: 98%

Short atrioventricular delay pacing therapy in young and old patients with hypertrophic obstructive cardiomyopathy: good long-term results and a low need for reinterventions

et al. 2017

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“…Low dose thiazide diuretics can also be given to reduce dyspnea, however it should be used cautiously to avoid hypovolemia. Dual-chamber pacing may be considered in addition to medical therapy, however there have been no real benefits reported in regards to clinically relevant endpoints (13,14). TASH has been established over the last years.…”

Section: Discussionmentioning

confidence: 99%

Hypertrophic obstructive cardiomyopathy—the Leipzig experience

Jawad¹,

Kuehl²,

Davierwala³

et al. 2017

Ann. Cardiothorac. Surg.

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Background: Management of hypertrophic obstructive cardiomyopathy (HOCM) has evolved considerably over the last fifty years, and includes medical treatment as well as septal myectomy (SM) to relief symptoms caused by left ventricular outflow tract obstruction (LVOTO). We report the Leipzig Heart Center experience in the surgical management of patients with HOCM. Methods:We collected data from all patient treated surgically with a myectomy for LVOTO in patients with HOCM between 1997 and 2016. Patients with absent data were excluded from our analysis. All data were obtained from our surgical database and analyzed retrospectively. Results:We identified 115 patients who underwent surgical treatment for HOCM, where a male:female ratio of 1.1:1, a mean age of 60.8±14.6 years and a body mass index of 27.7±4.5 were observed. The most common symptom was dyspnea (n=102). Of all patients, 50% had New York Heart Association (NYHA) III class symptoms. Arterial hypertension was the most common comorbidity (n=80). Preoperative transthoracic echocardiography showed a mean ejection fraction (EF) of 65.9%±9.7%, median septal thickness of 21.1±5.3 mm, systolic anterior motion of the mitral valve (MV) in 61.7% of patients, and mean LVOT gradient of 70.1±45.2 mmHg. Surgery resulted in a mean decrease of the septal thickness by 15±3.7 mm and LVOT gradient by 9.7±8.5 mmHg. Isolated SM was carried out on 20 patients. Postoperatively, we were able to notice a significant improvement in NYHA classification, in which patients with NYHA III benefitted most from SM. Long-term follow-up data up to 11.3±0.7 years were available for 114 patients. During follow-up, 16 patients died, and one patient was lost to follow up.Conclusions: Surgical treatment of LVOT in patients with HOCM is an effective intervention that improves cardiac function and quality of life (QoL) and is associated with a low operative risk.

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“…There are only a few studies comparing pacing with other nonpharmacological treatments [27–30], so we decided to compare the effect of ASA and DDD pacing during long-term monitoring. The uniqueness of this work lies in the long and similar followup in both compared groups—more than 7 years (ASA group) and more than 8 years (DDD pacing group).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Long‐Term Effect of Dual‐Chamber Pacing and Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy

Krejčí

Gregor

Zemánek

et al. 2013

The Scientific World Journal

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Introduction. Nonpharmacological treatment of patients with hypertrophic obstructive cardiomyopathy (HOCM) comprises surgical myectomy (SME), alcohol septal ablation (ASA), and dual-chamber (DDD) pacing. The aim of the study was to compare the long-term effect of DDD pacing and ASA in symptomatic HOCM patients. Patients and Methods. We evaluated retrospective data from three cardiocenters; there were 24 patients treated with DDD pacing included and 52 treated with ASA followed for 101 ± 49 and 87 ± 23 months, respectively. Results. In the group treated with DDD pacing, the left ventricle outflow tract gradient (LVOTG) decreased from 82 ± 44 mmHg to 21 ± 21 mmHg, and NYHA class improved from 2.7 ± 0.5 to 2.1 ± 0.6 (both P < 0.001). In the ASA-treated group, a decline in LVOTG from 73 ± 38 mmHg to 24 ± 26 mmHg and reduction in NYHA class from 2.8 ± 0.5 to 1.7 ± 0.8 were observed (both P < 0.001). The LVOTG change was similar in both groups (P = 0.264), and symptoms were more affected by ASA (P = 0.001). Conclusion. ASA and DDD pacing were similarly effective in reducing LVOTG. The symptoms improvement was more expressed in patients treated with ASA.

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Pacing for drug-refractory or drug-intolerant hypertrophic cardiomyopathy

Cited by 25 publications

References 204 publications

Short atrioventricular delay pacing therapy in young and old patients with hypertrophic obstructive cardiomyopathy: good long-term results and a low need for reinterventions

Short atrioventricular delay pacing therapy in young and old patients with hypertrophic obstructive cardiomyopathy: good long-term results and a low need for reinterventions

Hypertrophic obstructive cardiomyopathy—the Leipzig experience

Comparison of Long‐Term Effect of Dual‐Chamber Pacing and Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy

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