Antiarrhythmic drug cibenzoline attenuates left ventricular pressure gradient and improves transmitral Doppler flow pattern in patients with hypertrophic obstructive cardiomyopathy caused by midventricular obstruction.
BACKGROUND
Recent interventional and surgical therapies to attenuate left ventricular pressure gradient (LVPG) can be difficult to perform in patients with hypertrophic obstructive cardiomyopathy (HOCM) caused by midventricular obstruction (MVO), owing to the risk of inducing or deteriorating mitral regurgitation.


RESULTS
The effects of the antiarrhythmic drug, cibenzoline, on LVPG and left ventricular (LV) diastolic function estimated by the change in the transmitral Doppler flow pattern were examined in 23 patients with HOCM and MVO. Hemodynamic changes 2 h after a single dose of 200 mg of cibenzoline and 3 months after oral administration of 300-450 mg of cibenzoline per day were examined. At 2 h after the treatment, LVPG decreased from 79+/-37 mmHg to 24+/-21 mmHg (p < 0.0001). E-wave velocity significantly increased and A-wave velocity significantly decreased, and thus the E/A ratio increased from 0.83+/-0.39 to 1.36+/-0.50 (p < 0.0001). After 3 months of treatment, LVPG remained decreased, and the E-wave and A-wave velocities and the E/A ratio remained improved.


CONCLUSIONS
Cibenzoline can attenuate LVPG and ameliorate LV diastolic dysfunction in patients with HOCM caused by MVO, which suggests a new strategy for the management of this condition.
Hamada
Mareomi
M
Division of Cardiology, Uwajima City Hospital, Uwajima, Japan. mhamada@uwajima-mh.go.jp
Shigematsu
Yuji
Y
Inaba
Shinji
S
Aono
Jun
J
Ikeda
Shuntaro
S
Watanabe
Kouki
K
Ogimoto
Akiyoshi
A
Ohtsuka
Tomoaki
T
Hara
Yuji
Y
Higaki
Jitsuo
J
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D002312:Cardiomyopathy, Hypertrophic / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D014694:Ventricular Outflow Obstruction / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology
D000889:Anti-Arrhythmia Agents; D007093:Imidazoles; C032151:cifenline