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Mid-Term Results of Dual-Chamber Pacing in Children with Hypertrophic Obstructive Cardiomyopathy
Luis E. Alday1, Eva Bruno, Eduardo Moreyra
1Section of Pediatric Cardiology, Hospital Privado, Naciones Unidas 346, 5016 Cordoba, Argentina.
Insights
Permanent dual-chambered pacing (DDD) offers a safe alternative for children with severe hypertrophic obstructive cardiomyopathy (HOCM) unresponsive to medication. This pacing significantly reduces left ventricular outflow tract gradients and improves functional class.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Medical Devices
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) can be debilitating in children.
- Medical management is often insufficient for severe HOCM cases.
- Surgical options carry significant risks for pediatric patients.
Purpose of the Study:
- To evaluate the efficacy and safety of permanent dual-chambered pacing (DDD) in pediatric patients with severe HOCM.
- To assess the impact of DDD pacing on left ventricular outflow tract (LVOT) gradients and functional status.
- To determine the effect of DDD pacing on diastolic function in children with HOCM.
Main Methods:
- A cohort of five pediatric patients with severe HOCM underwent permanent DDD pacing.
- Patients were followed for an average of 21 months post-implantation.
- Doppler echocardiography was utilized for serial assessment of LVOT gradients and cardiac function.
Main Results:
- All patients demonstrated improvement in functional class after DDD pacing.
- Significant reduction in LVOT gradients was observed, from a baseline of 66 mmHg to 30 mmHg at mid-term follow-up (P < 0.05).
- No evidence of left ventricular systolic dysfunction or adverse effects on diastolic function was detected.
Conclusions:
- Permanent DDD pacing is a viable and effective alternative to surgery for children with severe HOCM.
- DDD pacing improves hemodynamic parameters and clinical status in this pediatric population.
- Doppler echocardiography is crucial for monitoring patients with HOCM undergoing DDD pacing.
Abstract:
BACKGROUND: Permanent dual-chambered pacing (DDD) is an alternative to surgical treatment in patients with severe hypertrophic obstructive cardiomyopathy (HOCM) who do not have a satisfactory response to medical treatment. METHODS: Five children with severe HOCM still symptomatic despite medical treatment underwent permanent DDD pacing and were followed for 21 +/- 9.7 months. RESULTS: All patients improved their functional class. Doppler echocardiographic studies showed an early reduction of the left ventricular outflow tract gradient from 66 +/- 40 to 40 +/- 20 mmHg (P < 0.05) and to 30 +/- 11 mmHg (P < 0.05 and NS for comparison with the baseline and the early post-DDD pacing gradients, respectively) at mid-term follow-up. There was no evidence of left ventricular systolic dysfunction, and the results of left ventricular filling studies ruled out deleterious effects on diastolic function. Doppler echocardiography played a key role in the initial and subsequent assessment of these patients. CONCLUSIONS: Permanent DDD pacing is a reasonable alternative to surgery in children with HOCM who are still symptomatic despite medical therapy.