Successful treatment of end-stage hypertrophic cardiomyopathy with biventricular cardiac pacing

Pezzulich, B.; Montagna, Laura; Lucchina, Pietro Greco

doi:10.1016/j.eupc.2004.12.013

Cited by 7 publications

(3 citation statements)

References 11 publications

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“…Cardiac resynchronization therapy (CRT) has a well‐established role in the treatment of patients with symptomatic heart failure, lowered ejection fraction of the left ventricle, and signs of abnormal intraventricular electrical conduction. Only two case reports show effectiveness of CRT in adult patients with HCM, expressed as reduction of intraventricular pressure gradient in a patient with obstructive form of disease 2 or as improvement in clinical status and performance of the left ventricle in the case of end‐stage cardiomyopathy 3 . Both patients presented with significant ventricular dyssynchrony at baseline and the authors attributed the effect of pacing to the restoration of electrical and mechanical synchrony of ventricles.…”

Section: Discussionmentioning

confidence: 99%

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

Lenarczyk

Kowalski

Kukulski

et al. 2007

Cardiovasc electrophysiol

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We present a case of a 10-year-old boy with hypertrophic cardiomyopathy, intraventricular pressure gradient of 104 mmHg, and indications for prophylactic ICD implantation. Based on intraoperative pressure measurements, the child was implanted with biventricular ICD. During 2.5 months of observation, the patient's functional status improved significantly, as shown by subjective and objective parameters and, moreover, the pressure gradient fell to 12 mmHg. Significant electrical and mechanical cardiac dyssynchrony appeared parallel to clinical improvement.

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Section: Discussionmentioning

confidence: 99%

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

Lenarczyk

Kowalski

Kukulski

et al. 2007

Cardiovasc electrophysiol

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“…BiV pacing is recommended for the treatment of heart failure in patients with reduced ejection fraction and electrocardiographic evidence of conduction delay [27]. This pilot study (and two recent case reports [28,29]) suggests that implantation of a BiV device is a useful adjunct to conventional heart failure therapy in patients with end‐stage HCM. As both LA dilatation [30] and the presence of mechanical dyssynchrony [11] have been shown to be associated with a worse prognosis in HCM, the significant improvements in ventricular and atrial dimensions seen in this study may confer important prognostic advantages including a reduction in stroke risk.…”

Section: Discussionmentioning

confidence: 93%

Effect of biventricular pacing on symptoms and cardiac remodelling in patients with end‐stage hypertrophic cardiomyopathy

Rogers

Marazìa

Chow

et al. 2008

European J of Heart Fail

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Background: Biventricular (BiV) pacing is an established therapy for heart failure in ischaemic and dilated cardiomyopathy. Its effects in endstage hypertrophic cardiomyopathy (HCM) are unknown. Aims: To assess the potential benefits of BiV pacing in patients with symptomatic end-stage HCM. Methods: Twenty patients with non-obstructive HCM (12 male, mean age 57 ± 13 years), left bundle branch block and symptoms of heart failure refractory to medical therapy underwent implantation of a BiV device. NYHA class, echocardiographic parameters and exercise capacity were assessed before and after implantation. Results: At a mean follow-up of 13 ± 6 months, an improvement of at least one NYHA class was reported in 8 (40%) patients. A clinical response was associated with an increase in ejection fraction (from 41 ± 14% to 50 ± 12%, p = 0.009), and reductions in left ventricular enddiastolic diameter (from 57 ± 6 mm to 52 ± 7 mm, p = 0.031) and left atrial diameter (from 65 ± 8 mm to 57 ± 6 mm, p = 0.005). Percentage predicted peak oxygen consumption was unchanged in responders but significantly declined in non-responders (p = 0.029). Conclusions: BiV pacing improved heart failure symptoms in a significant proportion of patients with end-stage HCM. Symptomatic improvement was associated with reverse remodelling of the left atrium and ventricle.

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“…Recently, biventricular pacing was reported to improve heart failure symptoms and reverse remodeling in end-stage HCM patients with LBBB in case reports and a series report. [ 28 29 30 ] In view of these findings, CRT is considered for HCM patients with refractory symptoms, LVEF <50%, and LBBB in the newly enacted European Society of Cardiology guideline (Class IIb, level C). [ 31 ] In addition, our study showed that the risk of mortality of mild systolic dysfunction was equal to that of severe systolic dysfunction by echocardiography, which strengthened the importance of early CRT management, even in mild systolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Prognosis of End-stage Hypertrophic Cardiomyopathy

Xiao

Yang

et al. 2015

Chinese Medical Journal

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Background:End-stage hypertrophic cardiomyopathy (HCM) is complicated by substantial adverse events. However, few studies have focused on electrocardiographic features and their prognostic values in HCM. This study aimed to evaluate the clinical manifestations and prognostic value of electrocardiography in patients with end-stage HCM.Methods:End-stage HCM patients were enrolled from a total of 1844 consecutive HCM patients from April 2002 to November 2013 at Fuwai Hospital. Clinical data, including medical history, electrocardiography, and echocardiography, were analyzed. Cox hazards regression analysis was used to assess the risk factors for cardiovascular mortality.Results:End-stage HCM was identified in 99 (5.4%) patients, averaged at 52 ± 16 years old at entry. Atrial fibrillation was observed in 53 patients and mural thrombus in 19 patients. During 3.9 ± 3.0 years of follow-up, embolic stroke, refractory heart failure, and death or transplantation were observed in 20, 39, and 51 patients, respectively. The incidence of annual mortality was 13.2%. Multivariate Cox hazards regression analysis identified New York Heart Association Class (NYHA) III/IV at entry (hazard ratio [HR]: 1.99; 95% confidence interval [CI]: 1.05–3.80; P = 0.036), left bundle branch block (LBBB) (HR: 2.80; 95% CI: 1.47–5.31; P = 0.002), and an abnormal Q wave (HR: 2.21; 95% CI: 1.16–4.23; P = 0.016) as independent predictors of cardiovascular death, in accordance with all-cause death and heart failure-related death.Conclusions:LBBB and an abnormal Q wave are risk factors of cardiovascular mortality in end-stage HCM and provide new evidence for early intervention. Susceptibility of end-stage HCM patients to mural thrombus and embolic events warrants further attention.

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Successful treatment of end-stage hypertrophic cardiomyopathy with biventricular cardiac pacing

Cited by 7 publications

References 11 publications

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

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

Effect of biventricular pacing on symptoms and cardiac remodelling in patients with end‐stage hypertrophic cardiomyopathy

Clinical Characteristics and Prognosis of End-stage Hypertrophic Cardiomyopathy

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