Document Detail

Late benefits of dual-chamber pacing in obstructive hypertrophic cardiomyopathy: a 10-year follow-up study.
MedLine Citation:
PMID:  19482844     Owner:  NLM     Status:  MEDLINE    
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 + or - 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 + or - 2.9, range 0.6-10.1). RESULTS: During the first year of follow-up, rest gradients decreased (baseline 86 + or - 29 mm Hg; 3 months 55 + or - 37; l year 41 + or - 26; p=0.0001). NYHA class improved, as well as exercise tolerance (baseline 281 + or - 112 m; 3 months 334 + or - 106 m; 1 year 348 + or - 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 + or - 10%; 3 months 74 + or - 8%; 1 year 66 + or - 13%; p=0.002). During the long-term follow-up, an additional reduction in obstruction was found (final rest gradient 28 + or - 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.
Enrique Galve; Antonia Sambola; Germ?n Salda?a; Iv?n Quispe; Elsa Nieto; Anna Diaz; Arturo Evangelista; Jaume Candell-Riera
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Publication Detail:
Type:  Journal Article     Date:  2009-05-28
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  96     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-03     Completed Date:  2010-06-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  352-6     Citation Subset:  AIM; IM    
Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Pg Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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MeSH Terms
Aged, 80 and over
Cardiac Pacing, Artificial / methods*
Cardiomyopathy, Hypertrophic / therapy*,  ultrasonography
Exercise Test
Follow-Up Studies
Middle Aged
Mitral Valve Insufficiency / therapy,  ultrasonography
Pacemaker, Artificial*
Prospective Studies
Ventricular Outflow Obstruction / therapy,  ultrasonography

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