ORIGINAL ARTICLE
DDDR
pacing for symptomatic patients
with
hypertrophic obstructive cardiomyopathy The first experience
in the Netherlands with pacing in HOCM
H.J. Achterberg, M.G. Scheffer, R
van
Mechelen, M.J.M. Kofflard, F.J. ten Cate
Background. Hypertrophic obstructive cardiomyopathy (HOCM) is a primary cardiac disorder with a heterogeneous expression. When medical therapy fails in patients with symptomatic HOCM, three additional therapeutic strategies exist: ventricular septal myectomy, alcohol-induced percutaneous transluminal septal myocardial ablation (PTSMA) of the first septal branch of the anterior descending artery and pacemaker implantation. In this paper we present the results of seven patients in whom a dual-chamber pacemaker was implanted to reduce the gradient in the left ventricular outflow tract (LVOT) and to relieve their symptoms. Methods. In patients with drug refractory symptomatic HOCM, not eligible for surgery, pacemaker therapy was recommended Symptomatic HOCM was defined as symptoms of angina and dyspnoea, functional class NYHA 3-4 and a resting LVOT gradient during Doppler echocardiography of more than 2.75 m/s (30 mmHg). In these patients, a dual-chamber pacemake was Implanted with a right ventricular lead positioned in the right ventricular apex and an atrial lead positioned in the right atrial appendage. In all patients the AV setting was programmed between 50 and 100 ms, using Doppler echocardiography to determine the optimal filling and to ensure ventricular capture. Results. A statistically significant reduction of the LVOT gradient was observed in all patients. The H.J. Achterberg. MG. Schwfhr. Department of Cardiology, MCRZ, location St. Clara Hospital, Rotterdam. R. van MecheWn. Department of Cardiology, St Franciscus Gasthuis, Rotterdam. MJ.M. KoMard. Department of Cardiology, Albert Schweitzer Hosptial, Dordrecht. F.J. ten Cate. Department of Cardiology, University Hospital Rotterdam. Address for correspondence: R. van Mechelen. E-mail: [email protected].
272
pre-implantation gradient in the LVOT measured by Doppler echocardiographyvaried from 3-5.8 m/s with ameanof4.7*1.1 m/s. Thepost-implantation gradient varied from 1.4-2.6 m/s with a mean of 1.9±0.4 m/s (p
DDDR
pacing for symptomatic patients
with
hypertrophic obstructive cardiomyopathy The first experience
in the Netherlands with pacing in HOCM
H.J. Achterberg, M.G. Scheffer, R
van
Mechelen, M.J.M. Kofflard, F.J. ten Cate
Background. Hypertrophic obstructive cardiomyopathy (HOCM) is a primary cardiac disorder with a heterogeneous expression. When medical therapy fails in patients with symptomatic HOCM, three additional therapeutic strategies exist: ventricular septal myectomy, alcohol-induced percutaneous transluminal septal myocardial ablation (PTSMA) of the first septal branch of the anterior descending artery and pacemaker implantation. In this paper we present the results of seven patients in whom a dual-chamber pacemaker was implanted to reduce the gradient in the left ventricular outflow tract (LVOT) and to relieve their symptoms. Methods. In patients with drug refractory symptomatic HOCM, not eligible for surgery, pacemaker therapy was recommended Symptomatic HOCM was defined as symptoms of angina and dyspnoea, functional class NYHA 3-4 and a resting LVOT gradient during Doppler echocardiography of more than 2.75 m/s (30 mmHg). In these patients, a dual-chamber pacemake was Implanted with a right ventricular lead positioned in the right ventricular apex and an atrial lead positioned in the right atrial appendage. In all patients the AV setting was programmed between 50 and 100 ms, using Doppler echocardiography to determine the optimal filling and to ensure ventricular capture. Results. A statistically significant reduction of the LVOT gradient was observed in all patients. The H.J. Achterberg. MG. Schwfhr. Department of Cardiology, MCRZ, location St. Clara Hospital, Rotterdam. R. van MecheWn. Department of Cardiology, St Franciscus Gasthuis, Rotterdam. MJ.M. KoMard. Department of Cardiology, Albert Schweitzer Hosptial, Dordrecht. F.J. ten Cate. Department of Cardiology, University Hospital Rotterdam. Address for correspondence: R. van Mechelen. E-mail: [email protected].
272
pre-implantation gradient in the LVOT measured by Doppler echocardiographyvaried from 3-5.8 m/s with ameanof4.7*1.1 m/s. Thepost-implantation gradient varied from 1.4-2.6 m/s with a mean of 1.9±0.4 m/s (p
