© 1999 by European Society of Cardiology
Clinical progress after randomized on/off pacemaker treatment for hypertrophic obstructive cardiomyopathy
BACKGROUND: The therapeutic options for hypertrophic obstructive cardiomyopathy (HOCM) classically include medical treatment with beta-blockers and calcium antag-onists 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.
Key Words: pacemaker, hypertrophic cardiomyopathy, randomized trial, quality of life, dual chamber pacing
Correspondence: Prof. L. Kappenberger, PIC Coordination Centre, Division of Cardiology, Centre Hospitalier Universitaire Vaudois (CHUV), CH-1011 Lausanne, Switzerland.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al. Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association Europace, October 1, 2007; 9(10): 959 - 998. [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al. Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association Eur. Heart J., September 2, 2007; 28(18): 2256 - 2295. [Full Text] [PDF]
|
|
|
|
|
|
H. Ashrafian, M. J. Mason, and A. G. Mitchell Regression of dilated-hypokinetic hypertrophic cardiomyopathy by biventricular cardiac pacing Europace, January 1, 2007; 9(1): 50 - 54. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, F. J. Ten Cate, et al. American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1687 - 1713. [Full Text] [PDF]
|
|
|
|
|
|
Writing Committee Members, B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, et al. American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines Eur. Heart J., November 1, 2003; 24(21): 1965 - 1991. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Rosa, J.-P. Maury, J. Terrand, X. Lyon, P. Kucera, L. Kappenberger, and E. Raddatz Ectopic pacing at physiological rate improves postanoxic recovery of the developing heart Am J Physiol Heart Circ Physiol, June 1, 2003; 284(6): H2384 - H2392. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Linde Reply J. Am. Coll. Cardiol., February 19, 2003; 41(4): 709 - 710. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Braunschweig, C. Linde, F. Gadler, and L. Ryden Reduction of hospital days by biventricular pacing Eur J Heart Fail, December 1, 2000; 2(4): 399 - 406. [Abstract] [Full Text] [PDF]
|
|