Resynchronization or Dyssynchronization—Successful Treatment with Biventricular Stimulation of a Child with Obstructive Hypertrophic Cardiomyopathy without Dyssynchrony

Lenarczyk, Radosław; Kowalski, Oskar; Kukulski, Tomasz; Kowalczyk, Jacek; Kalarus, Zbigniew

doi:10.1111/j.1540-8167.2007.00763.x

Cited by 12 publications

(7 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…By changing the timing of mechanical LV activation and inverting LV wall displacement, BiV might create changes in the 3-dimensional geometry of the LVOT and mitral valve apparatus resulting in the reduction of obstruction. As previously demonstrated[13], the acute reduction of gradient with BiVpacing supports this mechanical explanation for response and is corroborated by other short-term studies[15][16][17][19][20][21]30]. On a long-term basis, LV reverse remodeling might play an additional role as shown by significant reduction of septal and posterior wall thickness.…”

supporting

confidence: 80%

“…As an alternative, biventricular pacing (BiV) to reduce dynamic obstruction in hypertrophic obstructive cardiomyopathy (HOCM) has yielded encouraging results for reducing intraventricular obstruction and for clinical improvement [13][14][15][16][17][18][19][20][21]. However, while its effectiveness was demonstrated, the long-term effect of BiV-pacing on LV function among patients with HOCM and preserved LV ejection fraction is unknown.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dyssynchronization reduces dynamic obstruction without affecting systolic function in patients with hypertrophic obstructive cardiomyopathy: a pilot study

Giraldeau

Duchateau

Bijnens

et al. 2016

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

Dyssynchrony from biventricular pacing (BiV) can reduce dynamic obstruction in hypertrophic obstructive cardiomyopathy (HOCM), but its consequences on the left ventricular (LV) systolic function are unknown. We evaluate changes in LV systolic function and assess the effectiveness of BiV in HOCM. Thirteen patients with HOCM (55 [33/75] years, five males) received a BiV device and underwent 2D transthoracic echocardiography before the implantation and at 12 months follow-up. Global longitudinal and radial strain, and the timing of segmental displacement curves were measured by commercial speckle-tracking software to assess LV systolic function and dyssynchrony. Peak gradient in the LV outflow tract (LVOT) significantly decreased from 80 [51/100] to 30 [5/66] mmHg (p = 0.005). LV global strain was preserved from baseline to follow-up: 35.1 [20.2/43.8] % vs. 32.6 [27.1/44.1] %, p = NS (radial), and -16.6 [-19.1/-14.4] % vs. -15.7 [-17.0/-14.2] %, p = NS (longitudinal). Dyssynchrony analysis using displacement curves showed inversion of wall motion timing with earlier displacement of the lateral wall at follow-up only in patients with reduction in LVOT gradient. BiV reduces LVOT obstruction in patients with HOCM when dyssynchronization of LV motion and inversion of the timing of LV wall activation are reached. Notably, this does not lead to further deterioration of LV systolic function at mid-term follow-up.

show abstract

supporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Dyssynchronization reduces dynamic obstruction without affecting systolic function in patients with hypertrophic obstructive cardiomyopathy: a pilot study

Giraldeau

Duchateau

Bijnens

et al. 2016

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

show abstract

“…Data from adults indicate that automatic cardioverter–defibrillation offers secondary prevention against sudden cardiac death, but there is little data or consensus in pediatric patients [47,48]. Recent unexplained syncope was associated with an increased risk of sudden cardiac death [49], but indications for internal cardioverter–defibrillator insertion as both primary and secondary prophylaxis remain undefined [45].…”

Section: Hcm In Childhoodmentioning

confidence: 99%

Pediatric Cardiomyopathies: causes, epidemiology, Clinical course, Preventive Strategies and Therapies

et al. 2013

View full text Add to dashboard Cite

Pediatric cardiomyopathies, which are rare but serious disorders of the muscles of the heart, affect at least one in every 100,000 children in the USA. Approximately 40% of children with symptomatic cardiomyopathy undergo heart transplantation or die from cardiac complications within 2 years. However, a significant number of children suffering from cardiomyopathy are surviving into adulthood, making it an important chronic illness for both pediatric and adult clinicians to understand. The natural history, risk factors, prevalence and incidence of this pediatric condition were not fully understood before the 1990s. Questions regarding optimal diagnostic, prognostic and treatment methods remain. Children require long-term follow-up into adulthood in order to identify the factors associated with best clinical practice including diagnostic approaches, as well as optimal treatment approaches. In this article, we comprehensively review current research on various presentations of this disease, along with current knowledge about their causes, treatments and clinical outcomes.

show abstract

“…Later on, LV/biV pacing showed a significant LVOT gradient reduction superior to RVA pacing in HOCM patients without intraventricular conduction delay [29,33-35]. Recently, published data from three small studies suggest that LV/biV pacing might be efficient for LVOT gradient reduction and symptom improvement in a large proportion of HOCM patients not suitable for myectomy or ASA (Table 1) [36,39].…”

Section: The Case Of Atrial Synchronous LV or Biventricular Pacing Inmentioning

confidence: 99%

“…Alternatively, the reversed LV depolarization sequence [35] caused by pre-excitation of the LV posterolateral/lateral wall during LV/biV pacing may activate the longitudinally oriented epicardial fibres earlier, thereby advancing lateral wall longitudinal displacement with regard to interventricular septal longitudinal displacement [36] and potentially even slightly stretching the latter. This will change the pre-ejection shape and diameter of the LVOT and mitral valve, which, together with the induced reduction in septal systolic displacement, can reduce the intraventricular gradient.…”

Section: The Case Of Atrial Synchronous LV or Biventricular Pacing Inmentioning

confidence: 99%

Biventricular / Left Ventricular Pacing in Hypertrophic Obstructive Cardiomyopathy: An Overview

Vătăşescu

Evertz

Mont

et al. 2012

Indian Pacing and Electrophysiology Journal

View full text Add to dashboard Cite

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited genetic disease characterized by compensatory pathological left ventricle (LV) hypertrophy due to sarcomere dysfunction. In an important proportion of patients with HCM, the site and extent of cardiac hypertrophy results in severe obstruction to LV outflow tract (LVOT), contributing to disabling symptoms and increasing the risk of sudden cardiac death (SCD). In patients with progressive and/or refractory symptoms despite optimal pharmacological treatment, invasive therapies that diminish or abolish LVOT obstruction relieve heart failure-related symptoms, improve quality of life and could be associated with long-term survival similar to that observed in the general population. The gold standard in this respect is surgical septal myectomy, which might be supplementary associated with a reduction in SCD. Percutaneous techniques, particularly alcohol septal ablation (ASA) and more recently radiofrequency (RF) septal ablation, can achieve LVOT gradient reduction and symptomatic benefit in a large proportion of HOCM patients at the cost of a supposedly limited septal myocardial necrosis and a 10-20% risk of chronic atrioventricular block. After an initial period of enthusiasm, standard DDD pacing failed to show in randomized trials significant LVOT gradient reductions and objective improvement in exercise capacity. However, case reports and recent small pilot studies suggested that atrial synchronous LV or biventricular (biV) pacing significantly reduce LVOT obstruction and improve symptoms (acutely as well as long-term) in a large proportion of severely symptomatic HOCM patients not suitable to other gradient reduction therapies. Moreover, biV/LV pacing in HOCM seems to be associated with significant LV reverse remodelling.

show abstract

Resynchronization or Dyssynchronization—Successful Treatment with Biventricular Stimulation of a Child with Obstructive Hypertrophic Cardiomyopathy without Dyssynchrony

Cited by 12 publications

References 9 publications

Dyssynchronization reduces dynamic obstruction without affecting systolic function in patients with hypertrophic obstructive cardiomyopathy: a pilot study

Dyssynchronization reduces dynamic obstruction without affecting systolic function in patients with hypertrophic obstructive cardiomyopathy: a pilot study

Pediatric Cardiomyopathies: causes, epidemiology, Clinical course, Preventive Strategies and Therapies

Biventricular / Left Ventricular Pacing in Hypertrophic Obstructive Cardiomyopathy: An Overview

Contact Info

Product

Resources

About