Does Disopyramide Still Have a Place in the Management of Obstructive Hypertrophic Cardiomyopathy?
Stéphanie Corriveau1, Bobak Heydari2, Patrick Garceau3,4
1Bristol-Myers Squibb, Montréal, Québec, Canada.
Insights
Disopyramide is a potential treatment for obstructive hypertrophic cardiomyopathy (oHCM), a common inherited heart condition. However, robust clinical evidence supporting its use in oHCM is currently lacking.
Area of Science:
- Cardiology
- Genetics
- Pharmacology
Background:
- Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac disorder.
- Left ventricular hypertrophy is a key feature, potentially causing left ventricular outflow tract obstruction (oHCM).
- oHCM can lead to severe complications like sudden cardiac death and heart failure.
Purpose of the Study:
- To critically appraise the use of disopyramide for managing symptomatic obstructive hypertrophic cardiomyopathy (oHCM).
- To evaluate the existing clinical evidence for disopyramide in oHCM treatment.
Main Methods:
- Literature review and critical appraisal of available data on disopyramide for oHCM.
- Analysis of current treatment guidelines and expert opinions.
Main Results:
- Limited nonrandomized data and expert opinion support current pharmacologic treatments for oHCM.
- Robust clinical evidence for disopyramide's efficacy and safety in oHCM is lacking.
Conclusions:
- Disopyramide should be considered a last-resort treatment for oHCM.
- Reserve disopyramide for patients unresponsive to other pharmacologic therapies or unsuitable for invasive procedures.
Abstract:
Hypertrophic cardiomyopathy (HCM) is a relatively common inherited cardiac disorder associated with a left ventricular hypertrophy that cannot be explained by another cardiac or systemic disorder. One of the core pathophysiology features is left ventricular outflow tract obstruction (obstructive HCM [oHCM]), and this pathology could lead to complications, including sudden cardiac death and heart failure. Current treatment strategies for symptomatic oHCM consist of historical pharmacologic agents that are often based on nonrandomized, limited data or expert opinion. This article presents a critical appraisal of disopyramide, one of the pharmacologic options available in Canada for managing oHCM. The author concludes that robust clinical evidence supporting the use of disopyramide in treating oHCM is lacking, and that disopyramide should be reserved as a last resort for nonresponders to pharmacologic treatment and for those in whom invasive therapies are not indicated.
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