[Value of permanent cardiac pacing in hypertrophic and obstructive cardiomyopathies resistant to medical treatment].
The authors report their experience of long-term dual-chamber pacing in the treatment of hypertrophic and obstructive cardiomyopathy. Between August 1990 and March 1993, 16 patients (8 men, average age 53.5 +/- 18.9 years, range 21 and 79 years) with symptomatic hypertrophic obstructive cardiomyopathy resistant to medical therapy underwent electrophysiological investigation to assess atrioventricular conduction and the effects of temporary atrioventricular pacing on the intraventricular pressure gradient before implantation of a dual-chamber pacing system. The decision to implant was taken if the endocavitary studies showed severe atrioventricular conduction defects and/or if temporary pacing reduced the systolic pressure gradient by more than 30%. Temporary dual-chamber pacing led to a decrease of 48% of the systolic pressure gradient from 78.6 +/- 21.3 to 40.1 +/- 23.6 mmHg (p < 0.0005), a regression observed in 15 of the 16 patients. After an average follow-up period of 18.7 +/- 9.5 months (range 6 and 37 months), all 15 patients who received a dual-chamber pacing system were alive and were clinically improved. The systolic pressure gradient continued to decrease during the follow-up period (24.4 +/- 17.2 mmHg at the 6th month compared with 36.5 +/- 18.6 mmHg at the time of implantation; p = 0.014). The clinical improvement was dependent on careful adjustment of the atrioventricular delay which was programmed at relatively short values (65.6 +/- 14 ms, range 47 and 75 ms) to obtain permanent right ventricular capture. The authors conclude that dual-chamber pacing is an effective means of treating symptomatic hypertrophic obstructive cardiomyopathy resistant to medical therapy, even in the absence of preexisting conduction defects.
Sadoul
N
N
Service de cardiologie, CHU de Nancy, Hôpital central.
Simon
J P
JP
de Chillou
C
C
Bruntz
J F
JF
Isaaz
K
K
Beurrier
D
D
Reeb
T
T
Dodinot
B
B
Aliot
E
E
D000328:Adult; D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D010138:Pacemaker, Artificial / Q000009:adverse effects; D013997:Time Factors
Intérêts de la stimulation cardiaque permanente dans les myocardiopathies hypertrophiques et obstructives rebelles au traitement médical.