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[Acute and chronic sequential atrioventricular pacing in patients with obstructive-type hypertrophic myocardiopathy
J C Rodrigues1, T Ferreira, J Calaça
1Serviço de Cardiologia, Hospital Pulido Valente (HPV) de Lisboa.
Insights
Pacemaker implantation effectively treated obstructive hypertrophic cardiomyopathy in two women resistant to medication. This intervention reduced heart gradients and eliminated symptoms, improving quality of life.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Obstructive hypertrophic cardiomyopathy (oHCM) presents significant challenges, particularly in patients resistant to maximal medical therapy.
- Standard pharmacological treatments like beta-blockers, verapamil, and disopyramide may fail to manage severe symptoms and pressure gradients in oHCM.
Observation:
- Two female patients with highly symptomatic oHCM and medication resistance underwent DDD pacemaker implantation.
- The pacemaker featured right atrial and right ventricular apical leads, programmed for short atrioventricular (AV) delay to ensure ventricular pacing from the apex.
Findings:
- Pacemaker therapy resulted in a significant reduction, and in some cases elimination, of the left ventricular outflow tract (LVOT) gradient.
- Patients experienced complete resolution of symptoms including chest pain, shortness of breath, dizziness, palpitations, and fainting.
Implications:
- DDD pacemaker implantation offers a promising, less invasive alternative to surgical myectomy or myotomy for select oHCM patients.
- This therapeutic approach demonstrates potential for improved quality of life without the high morbidity and mortality associated with surgical interventions.
Abstract:
An evaluation was undertaken regarding two female patients suffering from obstructive hypertrophic cardiomyopathy, with high and strongly symptomatic gradients, as well as evidencing a resistance to medication with beta-blockers, verapamil and disopyramide when administered in maximal doses. These patients were provided with the implant of a definitive type DDD pacemaker, with an auricular electrocatheter placed on the right auricular appendix, and with a bipolar ventricular catheter placed on the apex of the right ventricle. The generator was programmed with a short AV so as to ensure that the ventricular stimulation would at any given time be the result of the ventricular contraction would be initiated at the apex portion of the right ventricle. With these therapeutics, we observed not only a reduction or even the gradient, but also the complete elimination of the existing symptoms--angor, dyspnea, dizziness, palpitations and fainting--with the resulting normalcy of the quality of life of the patients. All taken into account we are of the opinion that these therapeutics are, in the case of patients suffering from obstructive hypertrophic cardiomyopathy, a valid alternative for surgical treatment by means of myectomy or myotomy, but without the morbidity and mortality rates presented by such methods.