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Effect of biventricular pacing on symptoms and cardiac remodelling in patients with end‐stage hypertrophic cardiomyopathy
Author(s) -
Rogers Dominic P.S.,
Marazia Stefania,
Chow Anthony W.,
Lambiase Pier D.,
Lowe Martin D.,
Frenneaux Michael,
McKenna William J.,
Elliott Perry M.
Publication year - 2008
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2008.03.006
Subject(s) - medicine , cardiology , heart failure , ejection fraction , ventricle , hypertrophic cardiomyopathy , left bundle branch block , diastole , cardiomyopathy , refractory (planetary science) , stage (stratigraphy) , blood pressure , paleontology , physics , astrobiology , biology
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 mm to 52±7 mm, p =0.031) and left atrial diameter (from 65±8 mm 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.