Hypertrophic cardiomyopathy ventricular pacing: Difference between revisions
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(/* 2011 ACCF/AHA Guideline Recommendations: Pacing (DO NOT EDIT) {{cite journal |author=Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW |title=2...) |
(/* 2007 ESC Guidelines- Cardiac Pacing in HCM {{cite journal| author=Vardas PE, Auricchio A, Blanc JJ, Daubert JC, Drexler H, Ector H et al.| title=Guidelines for cardiac pacing and cardiac resynchronization therapy. The Task Force for Cardiac Pac...) |
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'''1.''' Patients with drug refractory hypertrophic cardiomyopathy with significant resting or provoked [[LVOT]] gradient <ref name="pmid1350522">{{cite journal| author=Fananapazir L, Cannon RO, Tripodi D, Panza JA| title=Impact of dual-chamber permanent pacing in patients with obstructive hypertrophic cardiomyopathy with symptoms refractory to verapamil and beta-adrenergic blocker therapy. | journal=Circulation | year= 1992 | volume= 85 | issue= 6 | pages= 2149-61 | pmid=1350522 | doi= | pmc= | url= }} </ref><ref name="pmid7994815">{{cite journal| author=Fananapazir L, Epstein ND, Curiel RV, Panza JA, Tripodi D, McAreavey D| title=Long-term results of dual-chamber (DDD) pacing in obstructive hypertrophic cardiomyopathy. Evidence for progressive symptomatic and hemodynamic improvement and reduction of left ventricular hypertrophy. | journal=Circulation | year= 1994 | volume= 90 | issue= 6 | pages= 2731-42 | pmid=7994815 | doi= | pmc= | url= }} </ref><ref name="pmid9458416">{{cite journal| author=Kappenberger L, Linde C, Daubert C, McKenna W, Meisel E, Sadoul N et al.| title=Pacing in hypertrophic obstructive cardiomyopathy. A randomized crossover study. PIC Study Group. | journal=Eur Heart J | year= 1997 | volume= 18 | issue= 8 | pages= 1249-56 | pmid=9458416 | doi= | pmc= | url= }} </ref> and contraindications for [[Hypertrophic cardiomyopathy interventional cardiology#Alcohol septal ablation|septal ablation]] or [[septal mectomy|myectomy]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: A]])'' | '''1.''' Patients with drug refractory hypertrophic cardiomyopathy with significant resting or provoked [[LVOT]] gradient <ref name="pmid1350522">{{cite journal| author=Fananapazir L, Cannon RO, Tripodi D, Panza JA| title=Impact of dual-chamber permanent pacing in patients with obstructive hypertrophic cardiomyopathy with symptoms refractory to verapamil and beta-adrenergic blocker therapy. | journal=Circulation | year= 1992 | volume= 85 | issue= 6 | pages= 2149-61 | pmid=1350522 | doi= | pmc= | url= }} </ref><ref name="pmid7994815">{{cite journal| author=Fananapazir L, Epstein ND, Curiel RV, Panza JA, Tripodi D, McAreavey D| title=Long-term results of dual-chamber (DDD) pacing in obstructive hypertrophic cardiomyopathy. Evidence for progressive symptomatic and hemodynamic improvement and reduction of left ventricular hypertrophy. | journal=Circulation | year= 1994 | volume= 90 | issue= 6 | pages= 2731-42 | pmid=7994815 | doi= | pmc= | url= }} </ref><ref name="pmid9458416">{{cite journal| author=Kappenberger L, Linde C, Daubert C, McKenna W, Meisel E, Sadoul N et al.| title=Pacing in hypertrophic obstructive cardiomyopathy. A randomized crossover study. PIC Study Group. | journal=Eur Heart J | year= 1997 | volume= 18 | issue= 8 | pages= 1249-56 | pmid=9458416 | doi= | pmc= | url= }} </ref> and contraindications for [[Hypertrophic cardiomyopathy interventional cardiology#Alcohol septal ablation|septal ablation]] or [[septal mectomy|myectomy]]. ''([[European society of cardiology#Level of Evidence|Level of Evidence: A]])'' | ||
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|colspan="1" style="text-align:center; background:LightCoral"|[[European society of cardiology#Classes of Recommendations|Class III]] | |||
'''1.''' Asymptomatic patients. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])'' | |- | ||
|bgcolor="LightCoral"|'''1.''' Asymptomatic patients. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])'' | |||
'''2.''' Symptomatic patients who do not have [[LVOT]] obstruction. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])'' | |- | ||
|bgcolor="LightCoral"|'''2.''' Symptomatic patients who do not have [[LVOT]] obstruction. ''([[European society of cardiology#Level of Evidence|Level of Evidence: C]])'' |} | |||
==Guideline Resources== | ==Guideline Resources== | ||
Revision as of 03:57, 3 October 2012
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Hypertrophic Cardiomyopathy Microchapters |
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Differentiating Hypertrophic Cardiomyopathy from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Hypertrophic cardiomyopathy ventricular pacing On the Web |
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Directions to Hospitals Treating Hypertrophic cardiomyopathy |
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Risk calculators and risk factors for Hypertrophic cardiomyopathy ventricular pacing |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D. [2]; Caitlin J. Harrigan [3]; Martin S. Maron, M.D.; Barry J. Maron, M.D.; Lakshmi Gopalakrishnan, M.B.B.S. [4]
Overview
The use of a pacemaker has been advocated in a subset of individuals, in order to cause asynchronous contraction of the left ventricle. Since the pacemaker activates the interventricular septum before the left ventricular free wall, the gradient across the left ventricular outflow tract may decrease. The AV interval must be shortened to do this, but not at the expense of diastolic filling. This form of treatment has been shown to provide less relief of symptoms and less of a reduction in the left ventricular outflow tract gradient when compared to surgical myectomy [1]. Dual chamber pacing does not decrease the risk of sudden cardiac death in these patients.
2011 ACCF/AHA Guideline Recommendations: Pacing (DO NOT EDIT) [2][3]
| Class III (No Benefit) |
| 1. Permanent pacemaker implantation for the purpose of reducing gradient should not be performed in patients with HCM who are asymptomatic or whose symptoms are medically controlled.(283,284,367) (Level of Evidence: C) |
| 2. Permanent pacemaker implantation should not be performed as a first-line therapy to relieve symptoms in medically refractory symptomatic patients with HCM and LVOT obstruction who are candidates for septal reduction.(283,284,367) (Level of Evidence: B) |
| Class IIa |
| 1. In patients with HCM who have had a dual-chamber device implanted for non-HCM indications, it is reasonable to consider a trial of dual-chamber atrial-ventricular pacing (from the right ventricular apex) for the relief of symptoms attributable to LVOT obstruction.(292,294,295,366) (Level of Evidence: B) |
| Class IIb |
| 1. Permanent pacing may be considered in medically refractory symptomatic patients with obstructive HCM who are suboptimal candidates for septal reduction therapy.(283,292,294,295,366) (Level of Evidence: B) |
2007 ESC Guidelines- Cardiac Pacing in HCM [4]
{{cquote|
Class IIa
1. Symptomatic bradycardia due to beta-blockade when alternative therapies are unacceptable. (Level of Evidence: C)
Class IIb
1. Patients with drug refractory hypertrophic cardiomyopathy with significant resting or provoked LVOT gradient [5][6][7] and contraindications for septal ablation or myectomy. (Level of Evidence: A)
| Class III |
| 1. Asymptomatic patients. (Level of Evidence: C) |
2. Symptomatic patients who do not have LVOT obstruction. (Level of Evidence: C) |}
Guideline Resources
References
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