| Title: |
Personalized permanent pacing guided by hemodynamic study as a treatment for drug-refractory symptomatic patients with obstructive hypertrophic cardiomyopathy |
| Authors: |
Rella, V; Caravita, S; Brasca, F M; Baratto, C; Rizzo, S; Girardengo, G; Salerno, S; Castelletti, S; Mariani, D; Cerea, P; Ravaro, S; Parati, G; Cecchi, F; Crotti, L; Perego, G B |
| Source: |
Europace ; volume 27, issue Supplement_1 ; ISSN 1099-5129 1532-2092 |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2025 |
| Description: |
Introduction Hypertrophic cardiomyopathy (HCM) patients with left ventricular outflow tract obstruction (LVOTO) often experience severe drug refractory symptoms. Overall, studies on gradient reduction by electrostimulation have led to contradictory results, possibly due to the heterogeneity of stimulation sites and intervals. Based on these conflicting data, current guidelines assign a class IIb indication for DDD pacing in HOCM patients without a bradycardia indication. Purpose We sought to validate the hypothesis that acute hemodynamic testing might be used to select the optimal right ventricular (RV), left (LV) or biventricular pacing site in order to achieve the maximum reduction in gradient and functional capacity improvement, in patients whose optimal medical therapy had failed. Methods Between 2016 and 2024, patients with obstructive HCM have been included if 1) symptomatic, 2) refractory to optimized medical therapy and 3) not or poorly eligible for septal myectomy or with an indication to implant a pacing device (pacemaker or ICD). Cardiac catheterization and temporary pacing were performed to identify the pacing site(s) among RV apex and suitable branches of the coronary sinus (CS) and the best configuration (RV only, LV only or biventricular) associated to the maximum reduction of LVOT gradient. Thereafter, all patients were implanted, regardless the results of acute stimulation test. Results The study population consisted of 10 patients with obstructive HCM (50% male) who underwent cardiac device implantation guided by haemodynamic testing. Mean age at implant was 76 ± 9 years. Of the 10 patients, 2 (20%) were referred for primary prevention ICD and 4 (40%) had pacing indication for bradycardia. Of those, 6 patients had resting obstruction documented by simultaneous LV apical and aortic pressure assessment > 30 mmHg, whereas 4 patients required gradient provocation via isoprenaline infusion. The mean pre-treatment invasive gradient was 111 ± 31 mmHg, versus 45 ± 20 mmHg during pacing ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1093/europace/euaf085.606 |
| Availability: |
https://doi.org/10.1093/europace/euaf085.606; https://academic.oup.com/europace/article-pdf/27/Supplement_1/euaf085.606/63304566/euaf085.606.pdf |
| Rights: |
https://creativecommons.org/licenses/by-nc/4.0/ |
| Accession Number: |
edsbas.9F013A3F |
| Database: |
BASE |