Key result
Permanent right ventricular apical pacing reduced the peak pressure gradient between the left ventricular apex and aorta from 73 mmHg to 55 mmHg and provided sustained symptomatic relief over 4 years.
Why the study?
Hypertrophic cardiomyopathy with LV mid-cavity obstruction and LV apical aneurysm carries high morbidity and mortality, but consensus is lacking on the optimal treatment modality.
Does permanent pacing reduce LV mid-cavity pressure gradient and improve symptoms in patients with hypertrophic cardiomyopathy with LV mid-cavity obstruction and apical aneurysm?
Case Report (n=1)
No
Does permanent pacing reduce LV mid-cavity pressure gradient and improve symptoms in patients with hypertrophic cardiomyopathy with LV mid-cavity obstruction and apical aneurysm?
Absolute Event Rate: 55% vs 73%
Permanent pacing may be an effective, relatively non-invasive treatment option for reducing pressure gradients and symptoms in patients with hypertrophic cardiomyopathy, LV mid-cavity obstruction, and apical aneurysm.
May offer relief in select hypertrophic cardiomyopathy cases with mid-cavity obstruction; hypothesis-generating and leaves open need for controlled trials.
Hypertrophic cardiomyopathy with left ventricular (LV) mid-cavity obstruction and LV apical aneurysm is associated with high morbidity and mortality rates. However, consensus is lacking on the treatment modality for LV mid-cavity obstruction and LV apical aneurysm. Here, we report a case of reduced LV mid-cavity pressure gradient and symptoms, treated using permanent pacing. The effect of permanent pacing on pressure gradient and symptoms lasted for 4 years. As pacing is relatively non-invasive compared to surgical therapy, permanent pacing is a good option, especially in the elderly patients with LV mid-cavity obstruction and apical aneurysm.
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Miura et al. (2019) conducted a case report in Hypertrophic cardiomyopathy with left ventricular mid-cavity obstruction and apical aneurysm (n=1). Permanent pacing (dual-chamber pacemaker, DDD mode) vs. Baseline (before pacing) was evaluated on Peak pressure gradient between the left ventricular apex and aorta (mmHg). Permanent right ventricular apical pacing reduced the peak pressure gradient between the left ventricular apex and aorta from 73 mmHg to 55 mmHg and provided sustained symptomatic relief over 4 years.
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