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Biventricular pacemaker therapy improves exercise capacity in patients with non-obstructive hypertrophic

Ibrar Ahmed1, Brodie L Loudon2, Khalid Abozguia1,3

  • 1Department of Cardiovascular Medicine, University of Birmingham, Birmingham, UK.

European Journal of Heart Failure
|January 25, 2020
PubMed

Insights

Biventricular pacing improves exercise capacity in non-obstructive hypertrophic cardiomyopathy (HCM) patients by enhancing diastolic filling, particularly in those with reduced exercise-induced volume changes. This offers a new treatment avenue for symptomatic HCM.

Area of Science:

  • Cardiology
  • Medical Devices
  • Exercise Physiology

Background:

  • Limited treatment options exist for non-obstructive hypertrophic cardiomyopathy (HCM).
  • Biventricular (BiV) pacing is a potential intervention, but its efficacy and mechanism in HCM require clarification.

Purpose of the Study:

  • To determine if BiV pacing improves exercise capacity in symptomatic non-obstructive HCM patients.
  • To investigate whether improvements are mediated by augmented diastolic filling during exercise.

Main Methods:

  • Thirty-one symptomatic non-obstructive HCM patients underwent BiV and sham pacing in a crossover study.
  • Exercise diastolic filling was assessed using radionuclide ventriculography.
  • Exercise capacity (peak oxygen consumption) and quality of life were evaluated over 8 months.

Main Results:

  • BiV pacing significantly increased exercise-induced left ventricular end-diastolic volume and stroke volume in patients with baseline reduced filling (-LVEDV group).
  • The -LVEDV group showed significant improvements in peak oxygen consumption and quality of life scores with BiV pacing.
  • No significant improvements in ejection fraction or end-systolic elastance were observed; no effect on mechanical dyssynchrony.

Conclusions:

  • Symptomatic non-obstructive HCM patients may benefit from BiV pacing through enhanced diastolic filling during exercise.
  • The mechanism appears to involve improved diastolic function rather than contractile enhancement.
  • Relief of diastolic ventricular interaction may contribute to observed benefits.
Abstract

Keywords:
Biventricular pacemaker therapyDiastolic ventricular interactionHypertrophic cardiomyopathy

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