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Effect of Cardiac Resynchronization on Gradient Reduction in Patients with Obstructive Hypertrophic Cardiomyopathy: Preliminary Study
Author(s) -
LENARCZYK RADOSŁAW,
WOŹNIAK ALEKSANDRA,
KOWALSKI OSKAR,
SOKAL ADAM,
PRUSZKOWSKASKRZEP PATRYCJA,
SREDNIAWA BEATA,
SZULIK MARIOLA,
ZIELIŃSKA TERESA,
KUKULSKI TOMASZ,
STABRYŁA JOANNA,
MAZUREK MICHAŁ,
BIAŁKOWSKI JACEK,
KALARUS ZBIGNIEW
Publication year - 2011
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2011.03193.x
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , ventricular outflow tract , qrs complex , obstructive cardiomyopathy , implantable cardioverter defibrillator , heart failure , cardiomyopathy , hypertrophic cardiomyopathy , ejection fraction
Background: The purpose of this study was to assess the effectiveness of cardiac resynchronization therapy (CRT) in terms of outflow tract gradient reduction and functional improvement in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) requiring implantable cardioverter‐defibrillator (ICD) implantation.Methods: Eleven consecutive symptomatic HOCM patients with a significant (≥40 mmHg) gradient and indications for ICD, but without indications for resynchronization, underwent CRT‐D implantation. Nine of them (four female, median age of 50 years) in whom the procedure succeeded were screened for New York Heart Association (NYHA) class, outflow gradient, mechanical dyssynchrony, QRS‐width change, and 6‐minute walking distance (6MWD) and peak oxygen consumption (VO 2 peak) improvement after 6 months and remotely .Results: After 6 months of pacing, NYHA class decreased (median 1 vs 2, respectively); peak (33 vs 84 mmHg) and mean (13 vs 38 mmHg) outflow tract gradients were reduced; and QRS width (143 vs 105 ms), intraventricular dyssynchrony (35 vs 55 ms), and VO 2 peak (19.5 vs 14.2 mL/kg/min) increased significantly (all P < 0.05) compared to baseline. In six of nine patients (67%), the peak gradient was reduced >50% and reached <40 mmHg. After a median of 36 months, the outflow gradient decreased even more (8 mmHg) and was significantly (P < 0.05) lower than after 6 months of CRT.Conclusions: These preliminary data suggest that CRT seems to be an effective method of reducing the outflow tract gradient and improving the functional status of symptomatic HOCM patients requiring ICD implantation. Our findings need to be confirmed by more extensive studies. (PACE 2011; 34:1544–1552)