Pacing in hypertrophic obstructive cardiomyopathy: A randomized crossover study

Abstract

Background Uncontrolled studies have shown that short atrioventricular delay dual chamber pacing reduces outflow tract obstruction in hypertrophic obstructive cardiomyopathy. Although the exact mechanism of this beneficial effect is unclear, this seems a promising potential new treatment for hypertrophic obstructive cardiomyopathy.Method In order to evaluate the impact of pacing therapy, we performed a randomized multicentre double-blind crossover (pacemaker activated vs non activated) study to investigate modification of echocardiography, exercise tolerance, angina, dyspnoea and quality of life in 83 patients with a mean age of 53 (range 22-87) years with symptoms refractory or intolerant to classical drug treatment.Results After 12 weeks of activated or inactivated pacing, independent of which phase was first, the pressure gradient fell from 59 ± 36 mmHg to 30 ± 25 mmHg (P<0001) with active pacing.Exercise tolerance improved by 21% in those patients who at baseline tolerated less than 10 min of Bruce protocol; symptoms of dyspnoea and angina also improved significantly from NYHA class 2-4 to 1-4 and 10 to 0-4, respectively (/"<0007). Quality of life assessment with a validated questionnaire objectivated the subjective improvement. ConclusionPacemaker therapy is of clinical and haemodynamic benefit for patients with hypertrophic obstructive cardiomyopathy, left ventricular outflow gradient at rest over 30 mmHg who are symptomatic despite drug treatment.

Conservative versus invasive treatment in hypertrophic obstructive cardiomyopathy: an echocardiography study

“…DDD pacemaker implantation with apical pre-excitation also has a benefi cial effect on LV remodeling and improvement of patients' symptoms. The effect of stimulation on LVOTG reduction is smaller and the achievement of comparable decline requires a longer time period, which was the cause of suboptimal LVOTG decrease in the studies PIC and M-PATHY with a shorter follow-up (13,14). A multicentric study comparing ASA and DDD pacing showed a statistically signifi cant LVOTG decrease and NYHA class improvement in both groups, although the effect of ASA was more pronounced and the result was achieved earlier (12).…”

“…The oldest of them is surgical myectomy, which was introduced into practice in the 1960's and is still considered (especially in the United States) as the fi rst option. Ten years later, dual-chamber pacemaker (PM DDD) implantation with apical pre-excitation was introduced and after initial promising results this method was relegated to the background later (12,13,14). If suitable coronary anatomy is present, the third method, alcohol septal ablation (ASA), can be indicated.…”

Wytyczne ESC dotyczące stymulacji serca i terapii resynchronizującej w 2013 roku

“…Zmniejszenie zawężenia drogi odpływu lewej komory i niespójny wpływ na objawy i jakość życia wykazano w 3 małych randomizowanych, kontrolowanych placebo badaniach z zastosowaniem trybu DDD wobec stymulacji AAI w obserwacyjnych badaniach długoterminowych [143][144][145][146][147][148]. Zasadniczo redukcja gradientu jest również mniejsza niż po operacji lub po ablacji alkoholowej przegrody.…”

Diretrizes para Avaliação e Tratamento de Pacientes com Arritmias Cardíacas

“…Em pacientes com a forma não-obstrutiva da doença, ou com gradiente <30mmHg não se observou melhora hemodinâ-mica objetiva 78 . Estudos recentes randomizados como o M-PATCHY e estudo PIC, não demonstraram vantagens clinicas do uso de marcapasso DDD em portadores de CMHO refratária a tratamento clínico, entretanto, revelaram redução evidente do gradiente na via de saída do VE 79,80 . O marcapasso modo DDD é, portanto, uma opção terapêutica para um grupo restrito de pacientes.…”