Impact of dual-chamber permanent pacing in patients with obstructive hypertrophic cardiomyopathy with symptoms refractory to verapamil and beta-adrenergic blocker therapy

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Circulation. 1992;85:2149-2161

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ARTICLES

Impact of dual-chamber permanent pacing in patients with obstructive hypertrophic cardiomyopathy with symptoms refractory to verapamil and beta-adrenergic blocker therapy

L Fananapazir, RO Cannon 3d, D Tripodi and JA Panza
Electrophysiology Section, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md 20892.

BACKGROUND. Patients with obstructive hypertrophic cardiomyopathy (HCM) with symptoms refractory to drugs (beta-blockers or verapamil) are candidates for cardiac surgery (left ventricular septal myectomy or mitral valve replacement). The present study examines prospectively the ability of dual-chamber (DDD) pacing to improve symptoms and relieve left ventricular outflow obstruction in such patients. METHODS AND RESULTS. Forty-four consecutive patients with obstructive HCM who had failed to benefit from pharmacotherapy underwent treadmill exercise tests, echocardiography, and cardiac catheterization before and 1.5-3 months after implantation of a DDD pacemaker. Symptoms (angina, dyspnea, palpitations, presyncope, and syncope), New York Heart Association functional class status (1.7 +/- 0.7 versus 3.4 +/- 0.5, p less than 0.00001), and exercise durations were improved at follow-up evaluation. This was associated with significant reduction in left ventricular outflow tract gradient (38 +/- 38 versus 87 +/- 43 mm Hg, p less than 0.0001) and significant increases in cardiac output and systemic arterial pressures. Notably, when pacing was discontinued and comparisons were made in sinus rhythm, treadmill exercise durations were greater and left ventricular outflow tract gradients were less at the follow-up evaluation compared with the baseline study. CONCLUSIONS. DDD pacing is an effective alternative to surgery in most patients with obstructive HCM with drug-refractory symptoms. The beneficial effects of pacing continue to be evident when pacing is acutely discontinued.

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				H. M. Spotnitz Pacemakers and Automatic Defibrillators Card. Surg. Adult, January 1, 2003; 2(2003): 1293 - 1326. [Full Text]

				W. Shamim, M. Yousufuddin, D. Wang, M. Henein, H. Seggewiss, M. Flather, A. J.S. Coats, and U. Sigwart Nonsurgical Reduction of the Interventricular Septum in Patients with Hypertrophic Cardiomyopathy N. Engl. J. Med., October 24, 2002; 347(17): 1326 - 1333. [Abstract] [Full Text] [PDF]

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				M. V. Sherrid, D. Z. Gunsburg, S. Moldenhauer, and G. Pearle Systolic anterior motion begins at low left ventricular outflow tract velocity in obstructive hypertrophic cardiomyopathy J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1344 - 1354. [Abstract] [Full Text] [PDF]

				N. M. Lakkis, S. F. Nagueh, J. K. Dunn, D. Killip, and W. H. Spencer III Nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy: one-year follow-up J. Am. Coll. Cardiol., September 1, 2000; 36(3): 852 - 855. [Abstract] [Full Text] [PDF]

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				D. A. Kass, C.-H. Chen, M. W. Talbot, C. E. Rochitte, J. A. C. Lima, R. D. Berger, and H. Calkins Ventricular Pacing With Premature Excitation for Treatment of Hypertensive-Cardiac Hypertrophy With Cavity-Obliteration Circulation, August 24, 1999; 100(8): 807 - 812. [Abstract] [Full Text] [PDF]

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				P. H. Pak, W. L. Maughan, K. L. Baughman, R. S. Kieval, and D. A. Kass Mechanism of Acute Mechanical Benefit From VDD Pacing in Hypertrophied Heart : Similarity of Responses in Hypertrophic Cardiomyopathy and Hypertensive Heart Disease Circulation, July 21, 1998; 98(3): 242 - 248. [Abstract] [Full Text] [PDF]

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				A. M. Kizilbash, S. K. Heinle, and P. A. Grayburn Spontaneous Variability of Left Ventricular Outflow Tract Gradient in Hypertrophic Obstructive Cardiomyopathy Circulation, February 10, 1998; 97(5): 461 - 466. [Abstract] [Full Text] [PDF]

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				M. D. Cheitlin, J. S. Alpert, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, T. W. Davidson, J. L. Davis, P. S. Douglas, L. D. Gillam, et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography Circulation, March 18, 1997; 95(6): 1686 - 1744. [Full Text]

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				R. B. McCully, R. A. Nishimura, A. J. Tajik, H. V. Schaff, and G. K. Danielson Extent of Clinical Improvement After Surgical Treatment of Hypertrophic Obstructive Cardiomyopathy Circulation, August 1, 1996; 94(3): 467 - 471. [Abstract] [Full Text]

				R. C. Robbins and E. B. Stinson LONG-TERM RESULTS OF LEFT VENTRICULAR MYOTOMY AND MYECTOMY FOR OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY J. Thorac. Cardiovasc. Surg., March 1, 1996; 111(3): 586 - 594. [Abstract] [Full Text]

				E. D. Wigle, H. Rakowski, B. P. Kimball, and W. G. Williams Hypertrophic Cardiomyopathy : Clinical Spectrum and Treatment Circulation, October 1, 1995; 92(7): 1680 - 1692. [Full Text]