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Late benefits of dual-chamber pacing in obstructive hypertrophic cardiomyopathy: a 10-year follow-up study
  1. Enrique Galve,
  2. Antonia Sambola,
  3. Germán Saldaña,
  4. Iván Quispe,
  5. Elsa Nieto,
  6. Anna Diaz,
  7. Arturo Evangelista,
  8. Jaume Candell-Riera
  1. Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain
  1. Correspondence to Enrique Galve, Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Pg Vall d'Hebron 119–129, 08035 Barcelona, Spain; egalve{at}vhebron.net

Abstract

Objective To examine the mid-term and long-term outcomes in patients with obstructive hypertrophic cardiomyopathy (HCM) submitted to pacing.

Design Prospective, observational study.

Setting Single, non-referral centre.

Patients and intervention Fifty patients (62±11 years) with HCM refractory to medical treatment, all in New York Heart Association (NYHA) class III or IV, and with a rest gradient >50 mm Hg underwent a dual-chamber pacemaker implantation. Patients were followed-up for up to 10 years (mean 5.0±2.9, range 0.6–10.1).

Results During the first year of follow-up, rest gradients decreased (baseline 86±29 mm Hg; 3 months 55±37; l year 41±26; p=0.0001). NYHA class improved, as well as exercise tolerance (baseline 281±112 m; 3 months 334±106 m; 1 year 348±78 m; p<0.0001). The physical and mental components of the quality of life instrument SF-36 also improved. Left ventricular wall thickness remained unchanged, while ejection fraction decreased (baseline 76±10%; 3 months 74±8%; 1 year 66±13%; p=0.002). During the long-term follow-up, an additional reduction in obstruction was found (final rest gradient 28±24 mm Hg, p<0.02). Those patients who did not improve to NYHA class I or II and continued to have obstruction were given other treatments (six, alcohol ablation; three, surgical myectomy).

Conclusions Pacing in HCM results in a significant reduction in obstruction, improvement of symptoms and exercise capacity that is progressive and may be achieved after a long period of time. In this series, only 18% of cases needed a more aggressive treatment to relieve residual obstruction and obtain a satisfactory symptomatic status. In conclusion, these results emphasise the need for new controlled studies of pacing with a longer follow-up.

  • Cardiomyopathy
  • hypertrophy
  • pacemaker
  • pacing

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Footnotes

  • Linked articles 173765.

  • Conflicts of interests None.

  • Ethics approval This study was conducted with the approval of the Comite Etico Hospital Vall D'Hebron.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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