دورية أكاديمية
Optimizing diastolic filling by pacing in nonobstructive hypertrophic cardiomyopathy.
| العنوان: | Optimizing diastolic filling by pacing in nonobstructive hypertrophic cardiomyopathy. |
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| المؤلفون: | Subramanian M; Department of Cardiology, AIG Institute of Cardiac Sciences and Research, Hyderabad, India., Shekar V; Department of Cardiology, AIG Institute of Cardiac Sciences and Research, Hyderabad, India., Krishnamurthy P; Department of Cardiology, AIG Institute of Cardiac Sciences and Research, Hyderabad, India., Yalagudri S; Department of Cardiology, AIG Institute of Cardiac Sciences and Research, Hyderabad, India., Kaur Saggu D; Department of Cardiology, AIG Institute of Cardiac Sciences and Research, Hyderabad, India., Atreya AR; Department of Cardiology, AIG Institute of Cardiac Sciences and Research, Hyderabad, India., Chennapragada S; Department of Cardiology, AIG Institute of Cardiac Sciences and Research, Hyderabad, India., Narasimhan C; Department of Cardiology, AIG Institute of Cardiac Sciences and Research, Hyderabad, India. Electronic address: calambur1@gmail.com. |
| المصدر: | Heart rhythm [Heart Rhythm] 2023 Sep; Vol. 20 (9), pp. 1307-1313. Date of Electronic Publication: 2023 May 19. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 101200317 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1556-3871 (Electronic) Linking ISSN: 15475271 NLM ISO Abbreviation: Heart Rhythm Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: New York, NY : Elsevier, c2004- |
| مواضيع طبية MeSH: | Pacemaker, Artificial* , Cardiomyopathy, Hypertrophic*/diagnosis , Cardiomyopathy, Hypertrophic*/therapy, Humans ; Male ; Adult ; Middle Aged ; Female ; Cardiac Pacing, Artificial/adverse effects ; Contrast Media ; Gadolinium |
| مستخلص: | Background: Treatment options for symptomatic patients with nonobstructive hypertrophic cardiomyopathy (nHCM) are limited. Objective: The purpose of this study was to determine the effect of sequential atrioventricular (AV) pacing, from different right ventricular (RV) sites with varying AV delays, on the diastolic function and functional capacity of patients with nHCM. Methods: Twenty-one patients with symptomatic nHCM and normal left ventricular (LV) systolic function were prospectively enrolled. Inclusion criteria included PR interval >150 ms, E/e' ≥15, and an indication for implantable cardioverter-defibrillator (ICD) implantation. Doppler echocardiographic study was performed during dual-chamber pacing at various AV intervals. Pacing was performed at 3 RV sites: RV apex (RVA), RV midseptum (RVS), and RV outflow tract (RVO). The site and sensed AV delay (SAVD) at which optimal diastolic filling occurred were chosen based on diastolic filling period and E/e'. During ICD implantation, the RV lead was implanted at the site identified by the pacing study. Devices were programmed in DDD mode at the optimal SAVD. During follow-up, diastolic function and functional capacity were assessed. Results: Among the 21 patients (age 47.8 ± 7.7 years; 81.0% male), baseline E/A and E/e' were 2.4 ± 0.6 and 17.2 ± 2.2, respectively. There was an improvement in diastolic function (E/e') in 18 patients (responders) when pacing from the RVA (12.9 ± 3.4; P <.001) than from the RVS (16.6 ± 2.3) and RVO (16.9 ± 2.2). Among responders, optimal diastolic filling occurred at SAVD of 130-160 ms with RVA pacing. Nonresponders had longer duration of symptoms (P = .006), lower LV ejection fraction (P = .037), and higher late gadolinium enhancement burden (P <.001). During 13.5 ± 1.5 months of follow-up, there was an improvement (Δ) in diastolic function (E/e' -4.1 ± 0.5), functional capacity (New York Heart Association functional class -1.5 ± 0.3), and reduction in N-terminal pro-brain natriuretic peptide level (-55.6 ± 12.3 pg/mL) compared to baseline. Conclusion: Pacing at an optimized AV delay from the RVA improves diastolic function and functional capacity in a subset of patients with nHCM. (Copyright © 2023 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.) |
| التعليقات: | Comment in: Heart Rhythm. 2023 Sep;20(9):1314-1315. (PMID: 37247687) |
| فهرسة مساهمة: | Keywords: Diastolic function; Dual-chamber pacing; Nonobstructive hypertrophic cardiomyopathy; Right ventricular apical pacing; atrioventricular delay |
| المشرفين على المادة: | 0 (Contrast Media) AU0V1LM3JT (Gadolinium) |
| تواريخ الأحداث: | Date Created: 20230520 Date Completed: 20230901 Latest Revision: 20230911 |
| رمز التحديث: | 20230912 |
| DOI: | 10.1016/j.hrthm.2023.05.021 |
| PMID: | 37210018 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1556-3871 |
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| DOI: | 10.1016/j.hrthm.2023.05.021 |