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Late benefits of dual-chamber pacing in obstructive hypertrophic cardiomyopathy. A 10-year follow-up study
  1. Enrique Galve (egalve{at}vhebron.net)
  1. Hospital Vall D'Hebron, Spain
    1. Antonia Sambola
    1. Hospital Vall D'Hebron, Spain
      1. German Saldaña
      1. Hospital Vall D'Hebron, Spain
        1. Ivan Quispe
        1. Hospital Vall D'Hebron, Spain
          1. Elsa Nieto
          1. Hospital Vall D'Hebron, Spain
            1. Anna Diaz
            1. Hospital Vall D'Hebron, Spain
              1. Arturo Evangelista
              1. Hospital Vall D'Hebron, Spain
                1. Jaume Candell-Riera
                1. Hospital Vall D'Hebron, Spain

                  Abstract

                  Objective: To examine the mid 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±11years) with HCM refractory to medical therapy, all in NYHA class III or IV, and with a rest gradient >50mmHg underwent a dual-chamber pacemaker implantation. Patients were followed-up 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±29mmHg; 3-months 55±37; l-year 41±26; p=0.0001). NYHA class improved (p<0.0001), as well as exercise tolerance (p<0.0001). The physical and mental components of the quality of life instrument SF-36 improved as well (p=0.0001). Left ventricular wall thickness remained unchanged, while ejection fraction decreased (p=0.002). During the long-term follow-up, an additional reduction in obstruction was found (final rest gradient 28±24mmHg, p<0.02). Those patients that did not improved to NYHA class I or II and remained with obstruction were submitted to other therapies (6 to alcohol ablation, 3 to 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 our series, only 18% of cases needed a more aggressive therapy to relieve residual obstruction and obtain a satisfactory symptomatic status. In conclusion, these results emphasize the necessity of new controlled studies of pacing with a longer follow-up.

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