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Pacing in hypertrophic obstructive cardiomyopathy. A randomized crossover study. PIC Study Group

L Kappenberger¹, C Linde, C Daubert

¹Division of Cardiology, CHUV, Lausanne, Switzerland.

European Heart Journal

|August 1, 1997

Summary

Pacemaker therapy significantly reduces left ventricular outflow tract obstruction in hypertrophic obstructive cardiomyopathy. This treatment improves exercise tolerance and quality of life for symptomatic patients.

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Area of Science:

Cardiology
Medical Devices
Clinical Trials

Background:

Short atrioventricular delay dual chamber pacing shows potential for reducing outflow tract obstruction in hypertrophic obstructive cardiomyopathy.
The precise mechanism behind this beneficial effect remains unclear.
This pacing approach presents a promising new treatment avenue for hypertrophic obstructive cardiomyopathy.

Purpose of the Study:

To evaluate the impact of pacemaker therapy on hypertrophic obstructive cardiomyopathy.
To assess modifications in echocardiography, exercise tolerance, angina, dyspnea, and quality of life.

Main Methods:

A randomized, multicenter, double-blind, cross-over study was conducted.
83 patients with drug-refractory symptoms underwent pacemaker activation vs. non-activation phases.
Evaluated echocardiography, exercise capacity, and symptom scores over 12 weeks.

Main Results:

Active pacing reduced the pressure gradient from 59 mmHg to 30 mmHg (P < 0.001).
Exercise tolerance improved by 21% in patients with baseline limitations.
Significant improvements were observed in dyspnea (NYHA class 2.4 to 1.4) and angina (1.0 to 0.4), alongside enhanced quality of life.

Conclusions:

Pacemaker therapy offers significant clinical and hemodynamic benefits for patients with hypertrophic obstructive cardiomyopathy.
Patients with a resting left ventricular outflow gradient over 30 mmHg and persistent symptoms benefit from this intervention.
This therapy represents an effective treatment option for managing severe, drug-resistant hypertrophic obstructive cardiomyopathy.