Does Pacemaker Implantation Provide Long-term Benefits in Severe Obstructive Hypertrophic Cardiomyopathy?

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• 作者：Mí ; riam S ; í ; n ; Francisco Marí ; n ; Francisco Cambronero ; Vicente Climent ; Cé ; sar Caro ; Juan Gabriel Martí ; nez ; Antonio Garcí ; a Honrubia ; Arcadio Garcí ; a Alberola ; Gonzalo de
• 关键词：Cardiomyopathy ; Pacemaker ; Obstruction
• 刊名：Revista Española de Cardiología (English Edition)
• 出版年：2009
• 出版时间：November 2009
• 年：2009
• 卷：62
• 期：11
• 页码：1233-1239
• 全文大小：193 K

文摘

Introduction and objectives

About 25 % of patients with obstructive hypertrophic cardiomyopathy (HCM) remain symptomatic despite optimal medical treatment. Some may benefit from pacemaker implantation. The aim of this study was to determine the effect of pacemaker implantation on the left ventricular outflow tract (LVOT) gradient, the maximum thickness of the left ventricle, and functional capacity.

Methods

In total, 72 patients with obstructive HCM and incapacitating symptoms underwent pacemaker implantation. Clinical examination, echocardiography (in 61 patients) and treadmill testing (in 34 patients) were performed before and after implantation.

Results

Subjective functional capacity, as assessed using the New York Heart Association (NYHA) classification, improved in 43.1 % of patients, but treadmill testing showed no change. There were significant reductions in subaortic gradient, from a median of 87.0 mm Hg (interquartile range [IQR], 61.5-115.2 mm Hg) to 30.0 mm Hg (IQR, 18.0-54.5 mm Hg; P<.001), and maximum left ventricular thickness, from 22.1 (4.5) mm to 19.8 (3.6) mm (P=.001). Univariate analysis identified 2 factors associated with clinical improvement: female sex (odds ratio [OR] = 3.43; P=.020) and functional class III/IV (OR=4.17; P=.009). On multivariate analysis, only functional class III/IV remained a significant predictor (OR=3.12; P=.048).

Conclusions

In patients with obstructive HCM and incapacitating symptoms, pacemaker implantation reduced the LVOT gradient and the maximum left ventricular thickness, but only 43.1 % of patients experienced clinical improvement. The only factor predictive of improvement was advanced NYHA functional class.