© 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.
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