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An Image Guided Transapical Mitral Valve Leaflet Puncture Model of Controlled Volume Overload from Mitral Regurgitation in the Rat
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Effects of permanent dual-chamber pacing on mitral regurgitation in hypertrophic obstructive cardiomyopathy

D Pavin1, C de Place, H Le Breton

  • 1Department of Cardiology, University Hospital, Rennes, France.

European Heart Journal
|March 19, 1999
PubMed

Insights

Dual-chamber pacing (DDD) effectively reduces mitral regurgitation and left ventricular outflow gradients in patients with hypertrophic obstructive cardiomyopathy. This treatment is beneficial even in patients with significant mitral regurgitation, provided there are no organic mitral valve abnormalities.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Cardiovascular Imaging

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) is often associated with mitral regurgitation (MR).
  • Left ventricular outflow tract (LVOT) obstruction is a hallmark of HOCM.
  • The role of pacing in managing MR in HOCM requires further elucidation.

Purpose of the Study:

  • To evaluate the impact of chronic dual-chamber pacing (DDD pacing) on mitral regurgitation in patients with HOCM.
  • To assess the correlation between pacing-induced changes in LVOT gradient and MR severity.

Main Methods:

  • A cohort of 23 patients with HOCM and MR underwent DDD pacing.
  • Mitral regurgitation was assessed using Doppler-echocardiography (semi-quantitative grading and regurgitant jet area/left atrial area ratio).
  • LVOT gradient was measured before and after pacing intervention.

Main Results:

  • DDD pacing significantly reduced the LVOT gradient (93 to 31 mmHg, P<0.0001).
  • A significant reduction in MR severity was observed, with 9 of 14 patients showing improvement (P<0.0001).
  • The regurgitant jet area/left atrial area ratio decreased from 20% to 11% (P<0.0001).

Conclusions:

  • DDD pacing effectively reduces both LVOT gradient and mitral regurgitation in HOCM patients without organic mitral valve disease.
  • Significant mitral regurgitation is not necessarily a contraindication for DDD pacing in HOCM.
  • The degree of MR reduction correlates with the achieved LVOT gradient in the absence of organic valve abnormalities.
Abstract

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