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Very late effects of dual chamber pacing therapy for obstructive hypertrophic cardiomyopathy

Adrien Lucon1, Laurent Palud, Dominique Pavin

  • 1Cardiology Division, Rennes University Hospital, France.

Archives of Cardiovascular Diseases
|June 29, 2013
PubMed

Insights

Dual chamber pacing significantly improved symptoms and heart function in hypertrophic obstructive cardiomyopathy (HOCM) patients long-term. Further controlled trials are recommended to confirm these findings for HOCM management.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Heart Failure Management

Background:

  • Long-term effects of dual chamber pacing for hypertrophic obstructive cardiomyopathy (HOCM) are not well-established.
  • Previous research on DDD pacing in HOCM presents controversial findings.

Purpose of the Study:

  • To assess the intermediate- and long-term clinical and hemodynamic outcomes of permanent dual chamber pacing in HOCM patients.
  • To evaluate the efficacy of DDD pacing as a primary treatment for HOCM.

Main Methods:

  • A cohort of 51 HOCM patients (NYHA class ≥ II) received DDD pacemakers (1991-2007).
  • Patients were followed for a mean of 11.5 years (range 0.4-21.8 years).
  • Clinical status, hemodynamic parameters, and survival rates were analyzed.

Main Results:

  • Significant improvement in NYHA class and reduction in left intraventricular (LV) gradient (mean 78% at 1-2 years, 89% at end-of-follow-up).
  • Mean LV ejection fraction decreased slightly (64% to 56%, P=0.05); LV end-diastolic diameter remained stable.
  • 5- and 10-year survival rates were 90% and 65%, respectively; 10 cardiovascular deaths occurred.

Conclusions:

  • Dual chamber pacing (DDD) effectively alleviates symptoms and improves hemodynamic function in HOCM patients long-term.
  • The findings suggest DDD pacing is a viable treatment option for HOCM.
  • Controlled trials are warranted to further validate these results.
Abstract

Keywords:
AVCardiomyopathie hypertrophique obstructiveCardiomyopathyDual chamber pacingHOCMHeart failureHypertrophic obstructive cardiomyopathyICDInsuffisance cardiaqueLVLVOTNYHANew York Heart AssociationRVStimulation cardiaque double-chambreTraitement électriqueatrioventricularhypertrophic obstructive cardiomyopathyimplantable cardioverter defibrillatorleft ventricularleft ventricular outflow tractright ventricular

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