title: Impact of right atrial-left ventricular dual-chamber permanent pacing in patients with severely symptomatic hypertrophic obstructive cardiomyopathy.
abstract: BACKGROUND
  Effective alternatives to surgical myectomy for patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) remain unestablished. Dual-chamber (DDD) pacing was evaluated in these patients using right atrial (RA) and epicardial left ventricular (LV) leads.
  
  
  RESULTS
  In 6 patients with HOCM refractory to medical therapy and conventional RA-right ventricular (RV) DDD pacing, we implanted DDD pacemakers using RA and epicardial LV leads. The baseline intraventricular pressure gradient before pacemaker implantation was 103+/-44 mmHg. The pressure gradient decreased significantly to 8+/-16 mmHg by temporary RA-LV DDD pacing (p=0.006), while it decreased only to 68+/-25 mmHg by temporary RA-RV pacing (NS). It was nearly eliminated to 1+/-2 mmHg (p=0.027) 3 months after RA-LV DDD pacemaker implantation. LV end-diastolic pressure, cardiac index and systolic aortic pressure did not change significantly. New York Heart Association class improved in all patients (p=0.023). Brain and atrial natriuretic peptide concentrations, respectively 516+/-286 and 143+/-34 pg/ml at baseline, decreased significantly to 230+/-151 and 93+/-44 pg/ml 3 months after implantation (p=0.027 and 0.028).
  
  
  CONCLUSIONS
  RA-LV DDD pacemaker implantation is a useful option for patients with symptomatic HOCM.
authors.affiliation: Division of Cardiology, Cardiovascular Center, Saiseikai Kumamoto Hospital, Japan. tohonda@skh.saiseikai.or.jp
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Honda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shono
authors.forename: Junjiro
authors.initials: J
authors.lastname: Koyama
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Masamichi
authors.initials: M
authors.lastname: Hayashi
authors.forename: Toitsu
authors.initials: T
authors.lastname: Hirayama
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Uesugi
authors.forename: Takashi
authors.initials: T
authors.lastname: Honda
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial; D002312:Cardiomyopathy, Hypertrophic / Q000503:physiopathology / Q000628:therapy*; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D018487:Ventricular Dysfunction, Left; D016276:Ventricular Function; D016277:Ventricular Function, Left