Biventricular pacing improved heart failure symptoms by at least one NYHA class in 40% of patients with end-stage hypertrophic cardiomyopathy, and increased ejection fraction (p=0.009).
Cohort (n=20)
Does biventricular pacing improve symptoms and cardiac remodelling in patients with end-stage hypertrophic cardiomyopathy?
Biventricular pacing may improve heart failure symptoms and induce reverse cardiac remodelling in a subset of patients with end-stage hypertrophic cardiomyopathy and left bundle branch block.
Abstract Background Biventricular (BiV) pacing is an established therapy for heart failure in ischaemic and dilated cardiomyopathy. Its effects in end-stage hypertrophic cardiomyopathy (HCM) are unknown. Aims To assess the potential benefits of BiV pacing in patients with symptomatic end-stage HCM. Methods Twenty patients with non-obstructive HCM (12 male, mean age 57±13 years), left bundle branch block and symptoms of heart failure refractory to medical therapy underwent implantation of a BiV device. NYHA class, echocardiographic parameters and exercise capacity were assessed before and after implantation. Results At a mean follow-up of 13±6 months, an improvement of at least one NYHA class was reported in 8 (40%) patients. A clinical response was associated with an increase in ejection fraction (from 41±14% to 50±12%, p=0.009), and reductions in left ventricular end-diastolic diameter (from 57±6 mm to 52±7 mm, p=0.031) and left atrial diameter (from 65±8 mm to 57±6 mm, p=0.005). Percentage predicted peak oxygen consumption was unchanged in responders but significantly declined in non-responders (p=0.029). Conclusions BiV pacing improved heart failure symptoms in a significant proportion of patients with end-stage HCM. Symptomatic improvement was associated with reverse remodelling of the left atrium and ventricle.
Rogers et al. (Fri,) conducted a cohort in End-stage hypertrophic cardiomyopathy (n=20). Biventricular pacing was evaluated on Improvement of at least one NYHA class. Biventricular pacing improved heart failure symptoms by at least one NYHA class in 40% of patients with end-stage hypertrophic cardiomyopathy, and increased ejection fraction (p=0.009).