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Cardiac resynchronization therapy in patients with end-stage hypertrophic cardiomyopathy

Ammar M Killu1, Jae-Yoon Park1, Jaskanwal D Sara1

  • 1Department of Cardiovascular Diseases.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|January 10, 2018
PubMed

Insights

Cardiac resynchronization therapy (CRT) did not improve ventricular function in patients with end-stage hypertrophic cardiomyopathy (HCM). However, CRT did not worsen heart function, though advanced therapies were still common.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Dilated/end-stage hypertrophic cardiomyopathy (HCM) is a recognized but rare clinical entity.
  • The efficacy of cardiac resynchronization therapy (CRT) in this specific patient population with reduced ejection fraction has not been previously investigated.

Purpose of the Study:

  • To evaluate the impact of bi-ventricular pacing via CRT on ventricular function and clinical outcomes in patients with dilated/end-stage HCM.

Main Methods:

  • Retrospective analysis of the Mayo Clinic HCM database.
  • Identification of 9 patients with HCM and ejection fraction (EF) <50% who received CRT, matched with 1:1 controls.
  • Clinical outcomes, including left ventricular assist device (LVAD) implantation, cardiac transplant, or death, were assessed.

Main Results:

  • CRT did not significantly improve ejection fraction at 6-month, 12-month, or long-term follow-up compared to baseline (34.7% ± 7.1% at implant).
  • There was no significant difference in the combined endpoint of LVAD, cardiac transplant, or death between the CRT and control groups (P=0.90).
  • In the CRT group, 89% were alive at last follow-up (mean 12.9 years), with 3 LVADs and 2 transplants; in the control group, 44.4% were alive (mean 12.0 years), with 1 LVAD and 1 transplant.

Conclusions:

  • Cardiac resynchronization therapy (CRT) does not appear to offer a significant benefit in improving ventricular function in patients with dilated/end-stage HCM.
  • While CRT did not lead to further deterioration of left ventricular function in the medium term, advanced heart failure therapies remained a common necessity in this cohort.
Abstract

Keywords:
Biventricular pacingCardiac resynchronization therapyDilated cardiomyopathyHypertrophic cardiomyopathy

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