Dual-Chamber Pacing in Hypertrophic Obstructive Cardiomyopathy

Sakai, Yasuhiko; Kawakami, Yoshihide; Hirota, Yuzo; Ito, Takahide; Shimada, Satoshi; Tokaji, Yasunobu; Suwa, Michihiro; Kawamura, Keishiro; Morimoto, Tomoshige; Nishimoto, Yasuhisa; Sasaki, Satoshi

doi:10.1253/jcj.63.971

Cited by 9 publications

(8 citation statements)

References 16 publications

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“…Acutely, pre-excitation of the right ventricular apex alters the dynamics and timing of the septal wall, which induces its paradoxical movement, avoids projection of the basal septum into the LVOT and thus decreases mitral valve apposition and, consequently, alleviates obstruction 28. However, it is well known that acute and chronic effects may differ substantially,15 and absence of gradient reduction initially may be associated with an important decrease later. This is probably due to a phenomenon of ventricular remodelling in relation to dyssynchrony that can have a delay and be present in the long term.…”

Section: Discussionmentioning

confidence: 99%

Late benefits of dual-chamber pacing in obstructive hypertrophic cardiomyopathy: a 10-year follow-up study

Galve

Sambola

Saldaña

et al. 2009

Heart

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Pacing in HCM results in a significant reduction in obstruction, improvement of symptoms and exercise capacity that is progressive and may be achieved after a long period of time. In this series, only 18% of cases needed a more aggressive treatment to relieve residual obstruction and obtain a satisfactory symptomatic status. In conclusion, these results emphasise the need for new controlled studies of pacing with a longer follow-up.

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Section: Discussionmentioning

confidence: 99%

Late benefits of dual-chamber pacing in obstructive hypertrophic cardiomyopathy: a 10-year follow-up study

Galve

Sambola

Saldaña

et al. 2009

Heart

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“…Early nonrandomized studies demonstrated that DDD pacing reduces LVOTO and improves symptoms [2,28,[45][46][47]. However, pacing in this fashion may have adverse effects on LV filling and worsen symptoms by impeding atrial transport and causing dysynchronous LV relaxation [48][49][50].…”

Section: Pacemaker Therapymentioning

confidence: 99%

Interventional Treatments for Hypertrophic Cardiomyopathy

Mohiddin

Knight

2011

Cardiovascular Therapeutics

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SUMMARYHypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder. This autosomal dominant condition is defined by left ventricular hypertrophy and associated with functional limitation and premature death. In fact, many individuals are asymptomatic and the annual mortality in most modern series is 1% or less. However, severe symptoms may develop at any age, and the risk of premature death from arrhythmia, stroke, and progressive systolic impairment may complicate asymptomatic disease. The clinical management of patients with HCM therefore encompasses (1) genetic counseling including discussion of indications for genetic testing and cascade family screening, (2) assessment of prognostic risk from ventricular arrhythmia, stroke, and heart failure, and (3) symptom management. This article describes the interventional treatments in the management of severe symptoms associated with left ventricular outflow tract obstruction (LVOTO).

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“…Baseline characteristics are in Table 1 and design features are in Table 2 . Most studies reported data at multiple follow-up durations 6 , 10 , 11 , 13–17 , 20 , 23 , 24 , 27 , 31 , 34–38 , 40–42 . Mean age was 55.5 years and mean baseline unpaced LVOTg was 78.9 mmHg.…”

Section: Resultsmentioning

confidence: 99%

Right ventricular pacing for hypertrophic obstructive cardiomyopathy: meta-analysis and meta-regression of clinical trials

Arnold

Howard

Chiew

et al. 2019

European Heart Journal - Quality of Care and Clinical Outcomes

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AimsRight ventricular pacing for left ventricular outflow tract gradient reduction in hypertrophic obstructive cardiomyopathy remains controversial. We undertook a meta-analysis for echocardiographic and functional outcomes.Methods and resultsThirty-four studies comprising 1135 patients met eligibility criteria. In the four blinded randomized controlled trials (RCTs), pacing reduced gradient by 35% [95% confidence interval (CI) 23.2–46.9, P < 0.0001], but there was only a trend towards improved New York Heart Association (NYHA) class [odds ratio (OR) 1.82, CI 0.96–3.44; P = 0.066]. The unblinded observational studies reported a 54.3% (CI 44.1–64.6, P < 0.0001) reduction in gradient, which was a 18.6% greater reduction than the RCTs (P = 0.0351 for difference between study designs). Observational studies reported an effect on unblinded NYHA class at an OR of 8.39 (CI 4.39–16.04, P < 0.0001), 450% larger than the OR in RCTs (P = 0.0042 for difference between study designs). Across all studies, the gradient progressively decreased at longer follow durations, by 5.2% per month (CI 2.5–7.9, P = 0.0001).ConclusionRight ventricular pacing reduces gradient in blinded RCTs. There is a non-significant trend to reduction in NYHA class. The bias in assessment of NYHA class in observational studies appears to be more than twice as large as any genuine treatment effect.

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Dual-Chamber Pacing in Hypertrophic Obstructive Cardiomyopathy

Cited by 9 publications

References 16 publications

Late benefits of dual-chamber pacing in obstructive hypertrophic cardiomyopathy: a 10-year follow-up study

Late benefits of dual-chamber pacing in obstructive hypertrophic cardiomyopathy: a 10-year follow-up study

Interventional Treatments for Hypertrophic Cardiomyopathy

Right ventricular pacing for hypertrophic obstructive cardiomyopathy: meta-analysis and meta-regression of clinical trials

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