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Clinical progress after randomized on/off pacemaker treatment for hypertrophic obstructive cardiomyopathy. Pacing in
L J Kappenberger1, C Linde, X Jeanrenaud
1PIC Coordination Centre, Division of Cardiology, Centre Hospitalier Universitaire Vaudois (CHUV), CH-1011 Lausanne, Switzerland.
Summary
Pacemaker implantation effectively reduces the subaortic gradient in patients with hypertrophic obstructive cardiomyopathy (HOCM) refractory to drug treatment. This safe and effective therapy improves symptoms and quality of life for most patients long-term.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) treatment options include medication or surgery.
- Pacemaker activation is known to reduce the subaortic gradient in HOCM but requires further investigation.
Purpose of the Study:
- To evaluate the efficacy and safety of pacemaker implantation in HOCM patients with drug-refractory symptoms and a significant subaortic gradient.
Main Methods:
- Prospective study of 83 HOCM patients with refractory symptoms and resting gradient >30 mmHg.
- Patients received DDD pacemaker implantation after favorable response to temporary pacing.
- Double-blind crossover phase (6 months) followed by 12-month reinvestigation and mean 36-month follow-up.
Main Results:
- Pacemaker significantly reduced the mean subaortic gradient from 72 mmHg to 29 mmHg (P < 0.01), an effect sustained at 1 year.
- Significant improvements observed in functional capacity (NYHA classification), quality of life, dyspnea, and angina.
- 83% of patients remained on pacing alone after a mean follow-up of 36 months, with 79% satisfied.
Conclusions:
- Pacemaker treatment is a safe and effective option for HOCM patients with refractory symptoms.
- It does not preclude alternative treatments and satisfies a majority of patients long-term.
- This study supports pacemaker implantation as a valuable therapeutic strategy for selected HOCM patients.