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Author Spotlight: Investigating HR-Dependent Cardiac Function in Mouse Models Through a Novel Atrial-Pacing Approach
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Optimizing diastolic filling by pacing in nonobstructive hypertrophic cardiomyopathy

Muthiah Subramanian1, Vijay Shekar1, Preetam Krishnamurthy1

  • 1Department of Cardiology, AIG Institute of Cardiac Sciences and Research, Hyderabad, India.

Heart Rhythm
|May 20, 2023
PubMed

Insights

Optimized sequential atrioventricular (AV) pacing from the right ventricular apex (RVA) improved diastolic function and functional capacity in patients with nonobstructive hypertrophic cardiomyopathy (nHCM). This pacing strategy offers a new treatment option for nHCM patients.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Cardiovascular Imaging

Background:

  • Limited treatment options exist for symptomatic patients with nonobstructive hypertrophic cardiomyopathy (nHCM).
  • Diastolic dysfunction is a key feature of nHCM, impacting functional capacity.

Purpose of the Study:

  • To evaluate the impact of sequential atrioventricular (AV) pacing from various right ventricular (RV) sites and AV delays on diastolic function and functional capacity in nHCM patients.
  • To identify optimal pacing parameters for improving cardiac function in nHCM.

Main Methods:

  • Prospective enrollment of 21 symptomatic nHCM patients with preserved left ventricular (LV) systolic function.
  • Echocardiographic assessment of diastolic function during dual-chamber pacing at different RV sites (apex, midseptum, outflow tract) and AV delays.
  • Identification of optimal pacing site and AV delay based on diastolic filling parameters and E/e' ratio.

Main Results:

  • RV apex (RVA) pacing at an optimized AV delay significantly improved diastolic function (E/e') in 18 of 21 patients (responders).
  • Responders achieved optimal diastolic filling with RVA pacing at sensed AV delays (SAVD) of 130-160 ms.
  • Non-responders exhibited longer symptom duration, lower LV ejection fraction, and higher late gadolinium enhancement burden.
  • During follow-up, responders showed significant improvements in diastolic function, functional capacity (NYHA class), and N-terminal pro-brain natriuretic peptide levels.

Conclusions:

  • Sequential AV pacing from the RVA with an optimized AV delay is an effective strategy for improving diastolic function and functional capacity in a subset of nHCM patients.
  • This pacing approach represents a promising therapeutic option for managing symptomatic nHCM.
Abstract

Keywords:
Diastolic functionDual-chamber pacingNonobstructive hypertrophic cardiomyopathyRight ventricular apical pacingatrioventricular delay

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