Sudden Death of a Case of Hypertrophic Obstructive Cardiomyopathy 19 Months After Successful Percutaneous Transluminal Septal Myocardial Ablation

Hirata, Kazuhito; Wake, Minoru; Asato, Hiroaki; Kyushima, Masahiro; Serizawa, Yoshimoto

doi:10.1253/circj.67.559

Cited by 4 publications

(4 citation statements)

References 14 publications

(11 reference statements)

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“…As widely available alternatives to surgical myectomy, we can mention the following 3 strategies: (1) medical therapy with -blockers, verapamil, and/or Ia antiarrhythmic drugs; 2,7,8 (2) percutaneous transluminal septal myocardial ablation; [4][5][6][7][8] and (3) DDD pacing therapy. 1,[7][8][9][10][11][12][13] In the 6 patients of the present study, medical therapy including -blocker, verapamil, or disopyramide, alone or in combination, could not produce sufficient effects.…”

Section: Discussionmentioning

confidence: 99%

“…3,4,6 Cardiac sudden death was rarely reported. 3,5 So we preferred RA-LV DDD pacing therapy. Many advantages are evident for RA-LV DDD pacing in patients with HOCM, some of which are shared by the usual RA-RV DDD pacing.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] As a widely available alternative to conventional surgical therapy, dual-chamber (DDD) pacing therapy with a short atrioventricular delay has been proposed. 1,9,10 Details of how DDD pacing relieves obstruction and decreases symptoms are not completely understood, but paradoxical motion of the interventricular septum induced by pacing from the right ventricular (RV) apex is considered to be a main mechanism.…”

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confidence: 99%

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

Honda

Shono

Koyama

et al. 2005

Circ J

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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)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Honda

Shono

Koyama

et al. 2005

Circ J

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“…Although therapies such as percutaneous myocardial ablation and surgical manipulation effectively reduce the LVOT gradient, they carry a risk of mortality and morbidity. [1][2][3] On the other hand, pacing therapy has is less invasive than the therapies mentioned above because it causes no rapid or irreversible anatomical changes. However, results of recent randomized studies have not been uniform and are considered controversial.…”

Section: Introductionmentioning

confidence: 99%

DDD Pacing Therapy Could Serve as a Dual Purpose Treatment in Hypertrophic Obstructive Cardiomyopathy-A Case Report Which Suggests the Importance of Lead Position and the Mechanism-

Takayanagi¹,

Toratani²,

Seino³

et al. 2007

J Arrhythmia

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We treated a patient with hypertrophic obstructive cardiomyopathy (HOCM) who underwent DDD pacing therapy. He suffered from attacks of paroxysmal atrial fibrillation (PAF) complicated by sick sinus syndrome. Initially, we were unable to decrease the left ventricular outflow tract (LVOT) gradient by pacing from the mid-distal portion of the right ventricular (RV) septum. However, by changing the pacing site to the apical portion guided by right ventriculography, it was possible to decrease the LVOT gradient and at the same time reduce the mitral regurgitation. Tissue Doppler imaging (TDI) revealed a marked motion delay of the ventricular septum during DDD pacing. The mechanism of the therapy for HOCM provided by the DDD pacing was clearly confirmed by TDI. Furthermore, a dramatic effect of preventing symptomatic PAF with the use of overdrive pacing in the region of Bachmann's bundle was also observed. This case report provides new insight into DDD pacing therapy for patients with HOCM. (J Arrhythmia 2007; 23: 245-249)

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Controlled myocardial infarction induced by intracoronary injection of n-butyl cyanoacrylatein dogs: A feasibility study

Matos

Hammadeh

François

et al. 2005

Cathet. Cardiovasc. Intervent.

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Concentrated ethanol has been used to induce controlled myocardial infarct in patients with hypertrophic obstructive cardiomyopathy. We report the acute and early follow-up results of an alternative agent, n-butyl cyanoacrylate (n-BCA) glue, in a dog model. In 11 mongrel dogs, we injected n-BCA into different branches of the left anterior descending artery. Biplane left ventriculogram and coronary angiogram were performed before and after injection. In the surviving animals, we performed programmed stimulation (PS) to test for inducible ventricular tachycardia (VT) 48 days later. Following euthanasia, the removed hearts were studied with computer tomography (CT) and gross and histologic examination. Three dogs were lost before injection. Four dogs died within 2 hr to 4 days, and four animals survived 48 days. Accidental embolization of n-BCA into nontarget vessels was documented in four subjects. In the n-BCA-injected animals, homogeneous circumscribed scar was demonstrated by CT and histology. The glue was confined strictly to the tributary of the injected vessel, infiltrating arterioles of 14 mum. There was intense granulomatous reaction (GR) in the vessel wall and in the surrounding myocardium. Remote areas were unaffected. Monomorphic VT was not inducible with PS. We report a feasibility study of n-BCA injection to selected coronary arteries of dogs to cause controlled myocardial infarction. We demonstrated that the glue does not escape from the target artery through capillaries or small collateral vessels and thus produces a sharply demarcated and homogeneous scar, which is confined strictly to the supply zone of the injected vessel. Improvement of the delivery system is necessary to eliminate inadvertent embolization. Long-term follow-up is needed to study the GR induced by n-BCA.

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Sudden Death of a Case of Hypertrophic Obstructive Cardiomyopathy 19 Months After Successful Percutaneous Transluminal Septal Myocardial Ablation

Cited by 4 publications

References 14 publications

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

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

DDD Pacing Therapy Could Serve as a Dual Purpose Treatment in Hypertrophic Obstructive Cardiomyopathy-A Case Report Which Suggests the Importance of Lead Position and the Mechanism-

Controlled myocardial infarction induced by intracoronary injection of n-butyl cyanoacrylatein dogs: A feasibility study

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