Clinical progress after randomized on/off pacemaker treatment for hypertrophic obstructive cardiomyopathy. Pacing in Cardiomyopathy (PIC) Study Group.
Details
Serval ID
serval:BIB_F3A631B2FF8F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Clinical progress after randomized on/off pacemaker treatment for hypertrophic obstructive cardiomyopathy. Pacing in Cardiomyopathy (PIC) Study Group.
Journal
Europace
ISSN
1099-5129
Publication state
Published
Issued date
1999
Peer-reviewed
Oui
Volume
1
Number
2
Pages
77-84
Language
english
Notes
Clinical Trial Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't --- Old month value: Apr
Abstract
BACKGROUND: The therapeutic options for hypertrophic obstructive cardiomyopathy (HOCM) classically include medical treatment with beta-blockers and calcium antagonists or myectomy-myotomy as a surgical possibility for refractory cases. The observation that pacemaker activation of the heart in HOCM reduces the subaortic gradient is well known but less well investigated. METHODS: Eighty-three patients (33 female and 50 male) mean age 53 (18-82) years, with symptoms refractory to drug treatment and a resting gradient above 30 mmHg, who responded favourably to temporary pacing, were included in this prospective study and had a pacemaker (DDD) implanted. After an initial double-blind crossover phase of 6 months, patients were reinvestigated at 12 months and followed for a mean of 36 months. RESULTS: As observed during a screening investigation, the obstruction was significantly reduced from 72 +/- 35 mmHg to 29 +/- 24 mmHg (P < 0.01) when the pacemaker was on, while no major effect was seen during the sham phase. The effect was persistent at 1 year with a remaining resting gradient of 28 +/- 24 mmHg. In parallel, we documented an improvement in functional capacity, according to the NYHA classification and by quality of life analysis, and a significant improvement in dyspnoea and angina. Exercise on treadmill improved only in patients with reduced initial tolerance (< 8 min). During the mean follow-up of 36 months, 65 patients remained on pacing alone, with eight patients having additional AV-node ablation and five patients finally having surgery. CONCLUSION: This controlled multicentre study shows that pacemaker treatment is an option for HOCM patients; it is inoffensive and does not exclude alternative methods, but satisfies 79% of patients beyond 3 years.
Keywords
Adolescent, Adult, Aged, Cardiomyopathy, Hypertrophic, Double-Blind Method, Exercise Tolerance, Female, Humans, Male, Middle Aged, Pacemaker, Artificial, Quality of Life, Treatment Outcome, Ventricular Outflow Obstruction
Pubmed
Web of science
Open Access
Yes
Create date
28/01/2008 10:45
Last modification date
20/08/2019 17:20