Effects of dual-chamber pacing in hypertrophic obstructive cardiomyopathy

Details

Serval ID
serval:BIB_C486EFE53AE4
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Effects of dual-chamber pacing in hypertrophic obstructive cardiomyopathy
Journal
Lancet
Author(s)
Jeanrenaud  X., Goy  J. J., Kappenberger  L.
ISSN
0140-6736 (Print)
Publication state
Published
Issued date
05/1992
Volume
339
Number
8805
Pages
1318-23
Notes
Journal Article
Research Support, Non-U.S. Gov't --- Old month value: May 30
Abstract
Although attempts have been made to treat hypertrophic obstructive cardiomyopathy with right ventricular pacing, the usual treatment for those refractory to medical therapy is open heart surgery. To assess in detail the value of non-surgical therapy the effects of acute and long-term dual-chamber pacing were investigated in 13 patients with hypertrophic obstructive cardiomyopathy refractory to medical treatment. In the first part of the study, atrioventricular (AV) sequential pacing was found to reduce peak subaortic pressure gradient in 12 of the 13 patients, from 82 (SD 42) to 47 (34) mm Hg (p less than 0.002), without concomitantly reducing aortic blood pressure or cardiac output. This effect was related to AV interval. In the second part of the study, a dual-chamber pacemaker was implanted in 8 patients and programmed to the optimum AV interval for the individual (50-90 ms). Patients were followed up for up to 62 months. Pacing resulted in a significant and long-lasting reduction in severity of angina pectoris (from NYHA class 3 to 1) and dyspnoea (from NYHA class 3 to 2). Echocardiography showed no significant change in septal thickness or left ventricular contractility but there was a trend to a spontaneous decrease in obstruction. In patients with hypertrophic obstructive cardiomyopathy, synchronised and ventricular pacing at optimum AV interval for the individual reduces the intraventricular pressure gradient and improves functional tolerance. Since the effect is longlasting, such pacing should be deemed an alternative therapy to surgery in selected cases.
Keywords
Adult Aged Angina Pectoris/classification/epidemiology/etiology Cardiomyopathy, Hypertrophic/complications/diagnosis/*therapy Coronary Angiography Dyspnea/classification/epidemiology/etiology Echocardiography Equipment Design/standards Female Follow-Up Studies Heart Catheterization Hemodynamic Processes Humans Male Middle Aged Pacemaker, Artificial/*standards Radionuclide Ventriculography Severity of Illness Index
Pubmed
Web of science
Create date
15/02/2008 12:29
Last modification date
20/08/2019 16:39
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