Late benefits of dual-chamber pacing in obstructive hypertrophic cardiomyopathy: a 10-year follow-up study. Issue 5 (28th May 2009)

• Record Type: Journal Article
• Authors: Galve, Enrique; Sambola, Antonia; Saldaña, Germán; Quispe, Iván; Nieto, Elsa; Diaz, Anna; Evangelista, Arturo; Candell-Riera, Jaume
• Is Part Of: Heart. Volume 96:Issue 5(2010)
• Page Start: 352
• Page End: 356
• Publication Date: 2009-05-28
• Subjects: Cardiomyopathy -- hypertrophy -- pacemaker -- pacing; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/hrt.2008.158915
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: To examine the mid-term and long-term outcomes in patients with obstructive hypertrophic cardiomyopathy (HCM) submitted to pacing. Design: Prospective, observational study. Setting: Single, non-referral centre. Patients and intervention: Fifty patients (62±11 years) with HCM refractory to medical treatment, all in New York Heart Association (NYHA) class III or IV, and with a rest gradient >50 mm Hg underwent a dual-chamber pacemaker implantation. Patients were followed-up for up to 10 years (mean 5.0±2.9, range 0.6–10.1). Results: During the first year of follow-up, rest gradients decreased (baseline 86±29 mm Hg; 3 months 55±37; l year 41±26; p=0.0001). NYHA class improved, as well as exercise tolerance (baseline 281±112 m; 3 months 334±106 m; 1 year 348±78 m; p<0.0001). The physical and mental components of the quality of life instrument SF-36 also improved. Left ventricular wall thickness remained unchanged, while ejection fraction decreased (baseline 76±10%; 3 months 74±8%; 1 year 66±13%; p=0.002). During the long-term follow-up, an additional reduction in obstruction was found (final rest gradient 28±24 mm Hg, p<0.02). Those patients who did not improve to NYHA class I or II and continued to have obstruction were given other treatments (six, alcohol ablation; three, surgical myectomy). Conclusions: 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.