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Dual chamber pacemaker therapy for mid-cavity obstructive hypertrophic cardiomyopathy

D Begley1, S Mohiddin, L Fananapazir

  • 1Inherited Heart Diseases Section, Cardiology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.

Pacing and Clinical Electrophysiology : PACE
|January 31, 2002
PubMed

Insights

Dual chamber (DDD) pacemaker therapy significantly improved symptoms and reduced pressure gradients in patients with mid-cavity obstructive hypertrophic cardiomyopathy (HCM). This therapy offers a viable alternative for patients unsuitable for traditional cardiac surgery.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Medical Devices

Background:

  • Intracavitary left ventricular (LV) obstruction is a key factor in hypertrophic cardiomyopathy (HCM) outcomes.
  • Mid-cavity obstructive HCM, sometimes with LV aneurysm, presents challenges for standard surgical intervention.
  • This specific obstruction pattern affects a minority of HCM patients and may indicate a poorer prognosis.

Purpose of the Study:

  • To evaluate the long-term efficacy of dual chamber (DDD) pacemakers in managing mid-cavity obstructive HCM.
  • To assess the impact of DDD pacing on symptoms, functional class, and hemodynamic parameters in this patient subset.

Main Methods:

  • A study involving 14 patients with mid-cavity obstructive HCM (mean age 34 years).
  • Patients received DDD pacemakers and were assessed via cardiac catheterization before and after therapy (6 months to 1 year follow-up).
  • Drug therapy was discontinued during the evaluation period.

Main Results:

  • All patients experienced symptomatic improvement, with a significant reduction in NYHA functional class (from 2.8 to 1.9, P < 0.0005).
  • Intracavitary LV pressure gradients decreased significantly (from 84 to 43 mmHg, P < 0.0005).
  • A significant reduction in apical LV systolic pressure and a trend towards increased exercise tolerance were observed.

Conclusions:

  • Chronic DDD pacing provides substantial symptomatic and hemodynamic benefits for patients with mid-cavity obstructive HCM.
  • This therapy is a valuable option for patients with this specific HCM subtype, where surgical options are less defined.

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