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Symptomatic hypertrophic obstructive cardiomyopathy: the role of dual-chamber pacing
M H Park1, D M Gilligan, N L Bernardo
1Division of Cardiology, McGuire Veterans Administration Medical Center, Richmond, Virginia 23249, USA.
Insights
Permanent dual-chamber (DDD) pacemakers offer a promising nonsurgical treatment for hypertrophic obstructive cardiomyopathy (HOCM) when medical therapy fails. This intervention significantly reduced symptoms and improved functional status in patients with HOCM.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) management traditionally involves beta blockers and calcium channel blockers, with surgery for refractory cases.
- Complications, mortality, and recurrence of limitations with existing therapies necessitate exploring alternative treatment modalities for HOCM.
Purpose of the Study:
- To evaluate the efficacy of permanent dual-chamber (DDD) pacemakers as an alternative treatment for symptomatic patients with HOCM.
Main Methods:
- A single-center study involving 10 symptomatic HOCM patients who received DDD pacemakers after medical therapy failure.
- Data collected included clinical, angiographic, echocardiographic, and electrophysiologic parameters.
- Patients presented with symptoms like dyspnea, chest pain, syncope, or presyncope, and were in NYHA functional class III or IV.
Main Results:
- DDD pacemaker implantation reduced the left ventricular outflow tract gradient from 83+/-44 mm Hg to 47.1+/-25.3 mm Hg.
- Eight out of 10 patients improved to New York Heart Association functional class 0 or I within 1 to 30 months post-implantation.
Conclusions:
- Permanent DDD pacemakers may serve as a viable nonsurgical option for selected symptomatic HOCM patients unresponsive to medical therapy.
- Further large-scale, multicenter, prospective, randomized trials are required to definitively establish the role of DDD pacemakers in HOCM treatment.
Background And Purpose:
The management of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) has traditionally consisted of beta blockers and calcium channel blockers. Surgical treatment has been employed for operable patients who became refractory to medical therapy. However, associated complications, mortality rate, and recurrence of functional limitations have shifted the focus toward alternative therapy modalities. Recently, permanent dual-chamber (DDD) pacemaker has been introduced as an alternative treatment option.
Patients And Methods:
This study comprises clinical, angiographic, echocardiographic, and electrophysiologic data obtained at a single center on 10 symptomatic patients with HOCM who received a DDD pacemaker after medical therapy failed to relieve symptoms. Presenting symptoms were exertional dyspnea and chest pain (60%), syncope (20%), and presyncope (20%). These symptoms were documented for 8.9+/-7.1 years before pacemaker implantation. All patients were in New York Heart Association functional class III or IV before pacemaker therapy.
Results:
Placement of a permanent DDD pacemaker decreased the left ventricular outflow tract gradient from 83+/-44 mm Hg (range: 35-180 mm Hg) to 47.1+/-25.3 mm Hg (range: 10-75 mm Hg) in these patients. Within 1 to 30 months, follow-up found that the functional status of eight out of the 10 patients had improved to New York Heart Association class 0 or I.
Conclusion:
In selected patients with symptomatic HOCM who fail to respond to medical therapy, DDD pacemaker may offer a nonsurgical alternative treatment option. Large-scale multicenter, prospective, randomized trials are needed to establish the role of this modality in the treatment of hypertrophic obstructive cardiomyopathy.