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Biventricular / left ventricular pacing in hypertrophic obstructive cardiomyopathy: an overview
Radu Vatasescu1, Reinder Evertz, Lluis Mont
1Cardiology Department, Clinic Emergency Hospital, Bucharest, Romania.
Indian Pacing and Electrophysiology Journal
|June 6, 2012
Summary
Atrial synchronous ventricular pacing, including biventricular (biV) pacing, shows promise in reducing left ventricular outflow tract (LVOT) obstruction and improving symptoms in hypertrophic cardiomyopathy (HCM) patients. This approach may also lead to significant left ventricular reverse remodeling.
Area of Science:
- Cardiology
- Genetics
- Internal Medicine
Background:
- Hypertrophic cardiomyopathy (HCM) is an inherited disorder causing left ventricle (LV) hypertrophy and potential LV outflow tract (LVOT) obstruction.
- LVOT obstruction in HCM leads to debilitating symptoms and increased risk of sudden cardiac death (SCD).
- Invasive therapies are considered for symptomatic patients refractory to medical management.
Purpose of the Study:
- To evaluate the efficacy of atrial synchronous LV or biventricular (biV) pacing in reducing LVOT obstruction and improving symptoms in HCM patients.
- To assess the impact of biV/LV pacing on LV reverse remodeling in HCM.
Main Methods:
- Review of case reports and small pilot studies on atrial synchronous LV or biV pacing in HCM patients.
- Comparison with outcomes of standard DDD pacing, surgical septal myectomy, alcohol septal ablation (ASA), and radiofrequency (RF) septal ablation.
Main Results:
- Standard DDD pacing failed to demonstrate significant LVOT gradient reduction or exercise capacity improvement in randomized trials.
- Atrial synchronous LV or biV pacing significantly reduced LVOT obstruction and improved symptoms in a majority of treated HCM patients.
- BiV/LV pacing was associated with significant LV reverse remodeling in HCM patients.
Conclusions:
- Atrial synchronous LV or biV pacing represents a promising therapeutic option for severely symptomatic HCM patients with LVOT obstruction, particularly those unsuitable for other interventions.
- This pacing strategy may offer symptomatic relief, improve quality of life, and induce beneficial reverse remodeling.
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