Sequential Atrioventricular Pacing in Patients With Hypertrophic Cardiomyopathy: An 18-year Experience.

Autor: Jurado Román A; Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain., Montero Cabezas JM; Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain. Electronic address: jmmonterocabezas@gmail.com., Rubio Alonso B; Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain., García Tejada J; Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain., Hernández Hernández F; Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain., Albarrán González-Trevilla A; Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain., Velázquez Martín MT; Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain., Coma Samartín R; Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain., Rodríguez García J; Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain., Tascón Pérez JC; Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.
Jazyk: angličtina
Zdroj: Revista espanola de cardiologia (English ed.) [Rev Esp Cardiol (Engl Ed)] 2016 Apr; Vol. 69 (4), pp. 377-83. Date of Electronic Publication: 2015 Dec 21.
DOI: 10.1016/j.rec.2015.08.023
Abstrakt: Introduction and Objectives: Controversy persists regarding the role of sequential atrioventricular pacing in patients with obstructive hypertrophic cardiomyopathy and disabling symptoms. The aim of this study was to evaluate the effect of pacing on symptoms, dynamic gradient, and left ventricular function in patients with hypertrophic cardiomyopathy.
Methods: From 1991 to 2009, dual-chamber pacemakers were implanted in 82 patients with obstructive hypertrophic cardiomyopathy and disabling symptoms despite optimal medical therapy. Sequential pacing was performed with a short atrioventricular delay. Clinical and echocardiographic parameters were measured before and immediately after implantation and after a long follow-up (median, 8.5 years [range, 1-18 years]).
Results: The New York Heart Association functional class was immediately reduced after pacemaker implantation in 95% of patients (P < .0001), and this improvement was maintained until the final follow-up in 89% (P = .016). The gradient was significantly reduced after implantation (94.5 ± 36.5 vs 46.4 ± 26.7mmHg; P < .0001) and at final follow-up (94.5 ± 36.5 vs 35.9 ± 24.0mmHg; P < .0001). Mitral regurgitation permanently improved in 52% of the patients (P < .0001). There were no differences in ventricular thickness or diameters, ejection fraction, or diastolic function.
Conclusions: Sequential pacing in selected patients with obstructive hypertrophic cardiomyopathy improves functional class and reduces dynamic gradient and mitral regurgitation immediately after pacemaker implantation and at final follow-up. Prolonged ventricular pacing has no negative effects on systolic or diastolic function in these patients.
(Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze: MEDLINE
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