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European Journal of Heart Failure 2008 10(5):507-513; doi:10.1016/j.ejheart.2008.03.006
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© 2008 European Society of Cardiology

Effect of biventricular pacing on symptoms and cardiac remodelling in patients with end-stage hypertrophic cardiomyopathy

Dominic P.S. Rogersa, Stefania Maraziaa, Anthony W. Chowa, Pier D. Lambiasea, Martin D. Lowea, Michael Frenneauxb, William J. McKennaa and Perry M. Elliotta,*

a The Heart Hospital, University College London UK
b Department of Cardiovascular Medicine, University of Birmingham UK

* Corresponding author. The Heart Hospital, 16-18 Westmoreland St, London W1G 8PH, UK. Tel.: +44 2075738888x4801; fax: +44 2075738838. E-mail addresses: minirogers{at}googlemail.com (D.P.S. Rogers), pelliott{at}doctors.org.uk (P.M. Elliott).


  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.

Key Words: Hypertrophic cardiomyopathy • Biventricular pacing • Remodelling • Heart failure • Cardiac resynchronisation

Received June 27, 2007; Revised December 27, 2007; Accepted March 12, 2008


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