Biventricular / Left Ventricular Pacing in Hypertrophic Obstructive Cardiomyopathy: An Overview

Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited genetic disease characterized by compensatory pathological left ventricle (LV) hypertrophy due to sarcomere dysfunction. In an important proportion of patients with HCM, the site and extent of cardiac hypertrophy results in severe...

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Main Authors:	Vatasescu, Radu, Evertz, Reinder, Mont, Lluis, Sitges, Marta, Brugada, Josep, Berruezo, Antonio
Format:	Online
Language:	English
Published:	Indian Heart Rhythm Society 2012
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356591/

id	pubmed-3356591
recordtype	oai_dc
spelling	pubmed-33565912012-06-04 Biventricular / Left Ventricular Pacing in Hypertrophic Obstructive Cardiomyopathy: An Overview Vatasescu, Radu Evertz, Reinder Mont, Lluis Sitges, Marta Brugada, Josep Berruezo, Antonio Review Article Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited genetic disease characterized by compensatory pathological left ventricle (LV) hypertrophy due to sarcomere dysfunction. In an important proportion of patients with HCM, the site and extent of cardiac hypertrophy results in severe obstruction to LV outflow tract (LVOT), contributing to disabling symptoms and increasing the risk of sudden cardiac death (SCD). In patients with progressive and/or refractory symptoms despite optimal pharmacological treatment, invasive therapies that diminish or abolish LVOT obstruction relieve heart failure-related symptoms, improve quality of life and could be associated with long-term survival similar to that observed in the general population. The gold standard in this respect is surgical septal myectomy, which might be supplementary associated with a reduction in SCD. Percutaneous techniques, particularly alcohol septal ablation (ASA) and more recently radiofrequency (RF) septal ablation, can achieve LVOT gradient reduction and symptomatic benefit in a large proportion of HOCM patients at the cost of a supposedly limited septal myocardial necrosis and a 10-20% risk of chronic atrioventricular block. After an initial period of enthusiasm, standard DDD pacing failed to show in randomized trials significant LVOT gradient reductions and objective improvement in exercise capacity. However, case reports and recent small pilot studies suggested that atrial synchronous LV or biventricular (biV) pacing significantly reduce LVOT obstruction and improve symptoms (acutely as well as long-term) in a large proportion of severely symptomatic HOCM patients not suitable to other gradient reduction therapies. Moreover, biV/LV pacing in HOCM seems to be associated with significant LV reverse remodelling. Indian Heart Rhythm Society 2012-05-20 /pmc/articles/PMC3356591/ /pubmed/22665960 Text en Copyright: © 2012 Berruezo et al. http://creativecommons.org/licenses/by/2.5/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Vatasescu, Radu Evertz, Reinder Mont, Lluis Sitges, Marta Brugada, Josep Berruezo, Antonio
spellingShingle	Vatasescu, Radu Evertz, Reinder Mont, Lluis Sitges, Marta Brugada, Josep Berruezo, Antonio Biventricular / Left Ventricular Pacing in Hypertrophic Obstructive Cardiomyopathy: An Overview
author_facet	Vatasescu, Radu Evertz, Reinder Mont, Lluis Sitges, Marta Brugada, Josep Berruezo, Antonio
author_sort	Vatasescu, Radu
title	Biventricular / Left Ventricular Pacing in Hypertrophic Obstructive Cardiomyopathy: An Overview
title_short	Biventricular / Left Ventricular Pacing in Hypertrophic Obstructive Cardiomyopathy: An Overview
title_full	Biventricular / Left Ventricular Pacing in Hypertrophic Obstructive Cardiomyopathy: An Overview
title_fullStr	Biventricular / Left Ventricular Pacing in Hypertrophic Obstructive Cardiomyopathy: An Overview
title_full_unstemmed	Biventricular / Left Ventricular Pacing in Hypertrophic Obstructive Cardiomyopathy: An Overview
title_sort	biventricular / left ventricular pacing in hypertrophic obstructive cardiomyopathy: an overview
description	Hypertrophic cardiomyopathy (HCM) is an autosomal dominant inherited genetic disease characterized by compensatory pathological left ventricle (LV) hypertrophy due to sarcomere dysfunction. In an important proportion of patients with HCM, the site and extent of cardiac hypertrophy results in severe obstruction to LV outflow tract (LVOT), contributing to disabling symptoms and increasing the risk of sudden cardiac death (SCD). In patients with progressive and/or refractory symptoms despite optimal pharmacological treatment, invasive therapies that diminish or abolish LVOT obstruction relieve heart failure-related symptoms, improve quality of life and could be associated with long-term survival similar to that observed in the general population. The gold standard in this respect is surgical septal myectomy, which might be supplementary associated with a reduction in SCD. Percutaneous techniques, particularly alcohol septal ablation (ASA) and more recently radiofrequency (RF) septal ablation, can achieve LVOT gradient reduction and symptomatic benefit in a large proportion of HOCM patients at the cost of a supposedly limited septal myocardial necrosis and a 10-20% risk of chronic atrioventricular block. After an initial period of enthusiasm, standard DDD pacing failed to show in randomized trials significant LVOT gradient reductions and objective improvement in exercise capacity. However, case reports and recent small pilot studies suggested that atrial synchronous LV or biventricular (biV) pacing significantly reduce LVOT obstruction and improve symptoms (acutely as well as long-term) in a large proportion of severely symptomatic HOCM patients not suitable to other gradient reduction therapies. Moreover, biV/LV pacing in HOCM seems to be associated with significant LV reverse remodelling.
publisher	Indian Heart Rhythm Society
publishDate	2012
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356591/
_version_	1611531403515658240

Biventricular / Left Ventricular Pacing in Hypertrophic Obstructive Cardiomyopathy: An Overview

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