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Effects of dual-chamber pacing for pediatric patients with hypertrophic obstructive cardiomyopathy

F Rishi1, J E Hulse, D O Auld

  • 1Children's Heart Center, Egleston Children's Hospital, Emory University, Atlanta, Georgia 30328, USA.

Journal of the American College of Cardiology
|March 15, 1997
PubMed

Insights

Dual-chamber pacing (DCP) effectively treats pediatric hypertrophic obstructive cardiomyopathy (HOCM) by reducing outflow tract gradients and improving symptoms. This therapy is beneficial for selected children unresponsive to medication.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Electrophysiology

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic heart condition causing left ventricular outflow tract (LVOT) obstruction.
  • Medications are often insufficient for symptomatic pediatric HOCM.
  • Dual-chamber pacing (DCP) has shown promise in adults with HOCM.

Purpose of the Study:

  • To evaluate the efficacy of temporary and permanent dual-chamber pacing (DCP) in pediatric patients with hypertrophic obstructive cardiomyopathy (HOCM).
  • To assess the impact of DCP on left ventricular outflow tract (LVOT) gradients and patient symptoms.

Main Methods:

  • Ten pediatric patients (age 1-17.5 years) with HOCM and LVOT gradient >= 40 mm Hg were studied.
  • Temporary pacing was assessed during cardiac catheterization.
  • Seven patients with hemodynamic improvement underwent permanent DCP implantation and were followed with questionnaires, Doppler, treadmill tests, and repeat catheterization.

Main Results:

  • Temporary pacing showed significant reduction in LVOT gradient, left ventricular systolic pressure, and pulmonary capillary wedge pressure in 70% of patients.
  • Permanent DCP led to significant symptom improvement (dyspnea, exercise intolerance) and sustained reduction in LVOT gradient at follow-up (23 months).
  • Congenital mitral valve abnormalities and rapid atrial rates were identified as factors precluding effective pacing in some patients.

Conclusions:

  • Permanent dual-chamber pacing (DCP) is an effective treatment for selected pediatric patients with hypertrophic obstructive cardiomyopathy (HOCM).
  • Careful patient selection is crucial, as certain conditions like congenital mitral valve abnormalities can limit pacing effectiveness.
Abstract

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