Effect of biventricular pacing on symptoms and cardiac remodelling in patients with end-stage hypertrophic cardiomyopathy

Dominic P.S. Rogers, Stefania Marazia, Anthony W. Chow, Pier D. Lambiase, Martin D. Lowe, Michael Frenneaux, William McKenna, Perry M. Elliott

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Abstract

Background: Biventricular (BiV) pacing is an established therapy for heart failure in ischaemic and dilated cardiomyopathy. Its effects in end-stage hypertrophic cardiomyopathy (HCM) are unknown.

Aims: To assess the potential benefits of BiV pacing in patients with symptomatic end-stage HCM.

Methods: Twenty patients with non-obstructive HCM (12 male, mean age 57 +/- 13 years), left bundle branch block and symptoms of heart failure refractory to medical therapy underwent implantation of a BiV device. NYHA class, echocardiographic parameters and exercise capacity were assessed before and after implantation.

Results: At a mean follow-up of 13 +/- 6 months, an improvement of at least one NYHA class was reported in 8 (40%) patients. A clinical response was associated with an increase in ejection fraction (from 41 +/- 14% to 50 +/- 12%, p=0.009), and reductions in left ventricular end-diastolic diameter (from 57 +/- 6 turn to 52 +/- 7 mm, p=0.031) and left atrial diameter (from 65 +/- 8 min to 57 +/- 6 mm, p=0.005). Percentage predicted peak oxygen consumption was unchanged in responders but significantly declined in non-responders (p=0.029).

Conclusions: BiV pacing improved heart failure symptoms in a significant proportion of patients with end-stage HCM. Symptomatic improvement was associated with reverse remodelling of the left atrium and ventricle. (C) 2008 Published by Elsevier B.V. on behalf of European Society of Cardiology.

Original languageEnglish
Pages (from-to)507-513
Number of pages7
JournalEuropean Journal of Heart Failure
Volume10
Issue number5
DOIs
Publication statusPublished - May 2008

Keywords

  • hypertrophic cardiomyopathy
  • biventricular pacing
  • remodelling
  • heart failure
  • cardiac resynchronisation
  • chronic heart-failure
  • diastolic ventricular interactions
  • resynchronization therapy
  • atrial-fibrillation
  • dyssynchrony
  • stimulation
  • responses
  • verapamil
  • exercise
  • volume

Cite this

Rogers, D. P. S., Marazia, S., Chow, A. W., Lambiase, P. D., Lowe, M. D., Frenneaux, M., McKenna, W., & Elliott, P. M. (2008). Effect of biventricular pacing on symptoms and cardiac remodelling in patients with end-stage hypertrophic cardiomyopathy. European Journal of Heart Failure, 10(5), 507-513. https://doi.org/10.1016/j.ejheart.2008.03.006