Ventricular pacing with premature excitation for treatment of hypertensive-cardiac hypertrophy with cavity-obliteration

Article

关键词: CONGESTIVE-HEART-FAILURE;    NORMAL SYSTOLIC FUNCTION;    CARDIOMYOPATHY;    PERSPECTIVE;    MANAGEMENT;    PREVALENCE;    CROSSOVER;    PROGNOSIS;    THERAPY;   

DOI  :  10.1161/01.CIR.100.8.807

来源: SCIE

【 摘 要 】

Background-Hypertensive left ventricular hypertrophy with supranormal systolic ejection and distal cavity obliteration (HHCO) can result in debilitating exertional fatigue and dyspnea. Dual-chamber pacing with ventricular preactivation generates discoordinate contraction, which can limit cavity obliteration and thereby increase potential ejection reserve. Accordingly, we hypothesized that pacing may improve exercise tolerance long-term in this syndrome. Methods and Results-Dual-chamber pacemakers were implanted in 9 patients with exertional dyspnea caused by HHCO. Intrinsic atrial rate was sensed, and ventricular preactivation was achieved by shortening the atrial-ventricular delay. Pacing was on or off for successive 3-month periods (randomized, double-blind, crossover design), followed by 6 additional pacing-on months. Metabolic exercise testing, quality-of-life assessment, and rest and dobutamine-stress echocardiographic/Doppler data were obtained. After 3 months of pacing-on, exercise duration rose from 324+/-133 to 588+/-238 s (mean+/-SD; P=0.001, with 7 of 9 patients improving greater than or equal to 30%), and maximal oxygen consumption increased from 13.6+/-2.9 to 16.7+/-3.3 mL of O-2.min(-1).kg(-1) (P<0.02). Both parameters were little changed from baseline during the pacing-off period. Improved exercise capacity persisted at I-year follow-up. Clinical symptoms and activities of daily living improved during the pacing-on period and stayed improved at 1 year, but they were little changed during the pacing-off period. Despite similar basal values, stroke volume (P<0.001) and cardiac output (P<0.02) increased with dobutamine stimulation 2 to 3 times more after 1 year of follow-up as compared with baseline. Conclusions-Long-term dual-chamber pacing can improve exercise capacity, cardiac reserve, clinical symptoms, and activities of daily living in patients with HHCO. This therapy may provide a novel alternative for patients in whom traditional pharmacological treatment proves inadequate.

【 授权许可】

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