Results of permanent dual-chamber pacing in symptomatic nonobstructive hypertrophic cardiomyopathy.
Because dual-chamber (DDD) pacing has been shown to be of benefit regarding symptoms, rest and pacing hemodynamics, and exercise duration in patients with obstructive hypertrophic cardiomyopathy (HC), the effect of DDD pacing was assessed in patients with nonobstructive HC who were significantly symptomatic despite medical management. Echocardiography, treadmill exercise testing, thallium-201 scintigraphy, radionuclide angiography, and invasive measurement of rest and semi-erect bicycle exercise hemodynamics were performed in 12 patients before and approximately 4 months after permanent DDD pacing. One patient died 3 months after pacemaker implantation, because of worsening diastolic heart failure. Of the remaining 11 patients, 10 improved regarding symptoms, and treadmill exercise duration was longer during DDD pacing than during the baseline study in sinus rhythm (6.8 +/- 2.8 to 8.5 +/- 2.8 minutes; p < 0.01), with a significant increase in the peak double product achieved (28.9 +/- 6.1 to 31.0 +/- 6.8 x 10(3); p < 0.05). However, there were significant reductions in cardiac (3.7 +/- 0.9 to 3.1 +/- 0.5 ml/min/m2; p < 0.01) and stroke volume (47.4 +/- 11.4 to 38.7 +/- 6.5 ml/beat/m2; p < 0.01) indexes, and a trend toward reduction in submaximal stroke volume index during DDD pacing as compared with the baseline study in sinus rhythm (44.7 +/- 13.5 to 40.9 +/- 10.9 ml/beat/m2; p = 0.097). No change in peak heart rate, cardiac or stroke volume index, mean blood pressure, or pulmonary artery or pulmonary capillary wedge pressure occurred with peak exercise during DDD pacing as compared with the initial exercise study in sinus rhythm.(ABSTRACT TRUNCATED AT 250 WORDS)
Cannon
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Cardiology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892.
Tripodi
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Dilsizian
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Panza
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JA
Fananapazir
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L
D000328:Adult; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D013997:Time Factors