Benefits of cardiac pacing in ICD recipients with hypertrophic cardiomyopathy

Abstract

Purpose

Implantable cardiac defibrillator (ICD) is the only definitive therapy for prevention of sudden cardiac death in hypertrophic cardiomyopathy (HCM). Conventional transvenous ICDs can provide cardiac pacing unlike new subcutaneous ICD, but the usefulness of cardiac pacing in HCM patients is not well defined. We sought to assess the usefulness of ICD pacing in HCM.

Methods

We retrospectively analyzed 93 HCM patients who had undergone ICD implantation at our center. Usefulness of pacing was defined as follows: 1) need of pacing due to bradycardia or AV conduction disturbances, 2) improvement of LV outflow tract obstruction by sequential AV pacing, 3) need for CRT pacing, or 4) successful antitachycardia pacing without a subsequent shock. Independent predictors of useful pacing were investigated by multivariable analysis.

Results

During a mean follow-up of 91.3 ± 5.5 months, 43 patients (46.2%) reached the composite endpoint. Independent predictors of pacing usefulness were older age (HR 1.36; 95%CI: 1.088–1.709; p=0.007) and NYHA functional class ≥ II (HR 2.15; 95%CI: 1.083–4.301; p=0.029). Twenty-eight (30.1%) patients had appropriate ICD interventions, triggered by a monomorphic ventricular tachycardia (MVT) in 22 of them (78.5%). In 17 individuals with MVT (77%), antitachycardia pacing successfully treated MVT.

Conclusions

In our HCM series of patients with ICD, 46% of individuals benefitted from cardiac pacing. MVT were documented in nearly 80% of the patients with ventricular arrhythmias and antitachycardia pacing successfully treated them in 77% of cases.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Maron BJ. Sudden death in young athletes. N Engl J Med. 2003;349:1064–75.

    CAS  Article  Google Scholar 

  2. 2.

    Maron BJ, Shen WK, Link MS, Epstein AE, Almquist AK, Daubert JP, et al. Efficacy of implantable cardioverter-defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy. N Engl J Med. 2000;342:365–73.

    CAS  Article  Google Scholar 

  3. 3.

    Maron BJ, Spirito P, Shen WK, Hass TS, Formisano F, Link MS, et al. Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy. JAMA. 2007;298:405–12.

    CAS  PubMed  Google Scholar 

  4. 4.

    Spirito P, Seidman CE, McKenna WJ, Maron BJ. The management of hypertrophic cardiomyopathy. N Engl J Med. 1997;336:775–85.

    CAS  Article  Google Scholar 

  5. 5.

    Kim JH, Malhotra R, Chiampas G, d’Hemecourt P, Troyanos C, Cianca J, et al. Cardiac arrest during long-distance running races. N Engl J Med. 2012;366:130–40.

    CAS  Article  Google Scholar 

  6. 6.

    Schinkel AF, Vriesendorp PA, Sijbrands EJ, Jordaens LJ, ten Cate FJ, Michels M. Outcome and complications after implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: systematic review and meta- analysis. Circ Heart Fail. 2012;5:552–9.

    CAS  Article  Google Scholar 

  7. 7.

    Wang N, Xie A, Tjahjono R, Tian DH, Phan S, Yan TD, et al. Implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy: an updated systematic review and meta-analysis of outcomes and complications. Ann Cardiothorac Surg. 2017;6:298–306.

    Article  Google Scholar 

  8. 8.

    Weinstock J, Bader YH, Maron MS, Rowin EJ, Link MS. Subcutaneous implantable cardioverter defibrillator in patients with hypertrophic cardiomyopathy: an initial experience. J Am Heart Assoc. 2016;5.

  9. 9.

    Lambiase PD, Gold MR, Hood M, Boersma L, Theuns DAMJ, Burke MC, et al. Evaluation of subcutaneous ICD early performance in hypertrophic cardiomyopathy from the pooled EFFORTLESS and IDE cohorts. Heart Rhythm. 2016;13:1066–74.

    Article  Google Scholar 

  10. 10.

    Cha YM, Gersh BJ, Maron BJ, Boriani G, Spirito P, Hodge DO, et al. Electrophysiologic manifestations of ventricular tachyarrhythmias provoking appropriate defibrillator interventions in high-risk patients with hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol. 2007;18:483–7.

    Article  Google Scholar 

  11. 11.

    O’Mahony C, Lambiase PD, Rahman SM, Cardona M, Calcagnino M, Quarta G, et al. The relation of ventricular arrhythmia electrophysiological characteristics to cardiac phenotype and circadian patterns in hypertrophic cardiomyopathy. Europace. 2012;14:724–33.

    Article  Google Scholar 

  12. 12.

    Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2733–79.

    Article  Google Scholar 

  13. 13.

    Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace. 2013 Aug;15(8):1070–118.

    Article  Google Scholar 

  14. 14.

    Barriales-Villa R, Centurión-Inda R, Fernández-Fernández X, Ortiz MF, Pérez-Alvarez L, Rodríguez García I, et al. Severe cardiac conduction disturbances and pacemaker implantation in patients with hypertrophic cardiomyopathy. Rev Esp Cardiol. 2010;63:985–8.

    Article  Google Scholar 

  15. 15.

    Nishimura RA, Trusty JM, Hayes DL, Ilstrup DM, Larson DR, Hayes SN, et al. Dual-chamber pacing for hypertrophic cardiomyopathy: a randomized, double-blind, crossover trial. J Am Coll Cardiol. 1997;29:435–41.

    CAS  Article  Google Scholar 

  16. 16.

    Kappenberger L, Linde C, Daubert C, McKenna W, Meisel E, Sadoul N, et al. Pacing in hypertrophic obstructive cardiomyopathy. A randomized crossover study. PIC Study Group. Eur Heart J. 1997;18:1249–56.

    CAS  Article  Google Scholar 

  17. 17.

    Maron BJ, Nishimura RA, McKenna WJ, Rakowski H, Josephson ME, Kieval RS. Assessment of permanent dual chamber pacing as a treatment for drug-refractory symptomatic patients with obstructive hypertrophic cardiomyopathy. A randomized, double-blind, crossover study (M-PATHY). Circulation. 1999;99:2927–33.

    CAS  Article  Google Scholar 

  18. 18.

    Wathen MS, DeGroot PJ, Sweeney MO, Stark AJ, Otterness MF, Adkisson WO, et al. PainFREERx II Investigators. Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter-defibrillators: Pacing Fast Ventricular Tachycardia Reduces Shock Therapies(PainFREERxII) trial results. Circulation. 2004;110:2591–625.

    Article  Google Scholar 

  19. 19.

    Dallaglio PD, di Marco A, Moreno Weidmann Z, Perez L, Alzueta J, García-Alberola A, et al. Antitachycardia pacing for shock prevention in patients with hypertrophic cardiomyopathy and ventricular tachycardia. Heart Rhythm. 2020;17:1084–91.

    Article  Google Scholar 

  20. 20.

    Wilkoff BL, Williamson BD, Stern RS, Moore SL, Lu F, Lee SW, et al. Strategic programming of detection and therapy parameters in implantable cardioverter-defibrillators reduces shocks in primary prevention patients: results from the PREPARE (Primary Prevention Parameters Evaluation) study. J Am Coll Cardiol. 2008;52:541–50.

    Article  Google Scholar 

  21. 21.

    Moss AJ, Schuger C, Beck CA, Brown MW, Cannom DS, Daubert JP, et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med. 2012;367:275–83.

    Article  Google Scholar 

  22. 22.

    Gasparini M, Proclemer A, Klersy C, Kloppe A, Lunati M, Ferrer JB, et al. Effect of long-detection interval vs standard-detection interval for implantable cardioverter defibrillators on antitachycardia pacing and shock delivery: the ADVANCE III randomized clinical trial. JAMA. 2013;309:1903–11.

    CAS  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Diego Jiménez-Sánchez.

Ethics declarations

Conflict of interest

J.T.R. is a member of the Medtronic European Advisory Board. Has received training course fees from Medtronic, Abbott, and Boston. All other authors did not have a conflict of interest to declare.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jiménez-Sánchez, D., Castro-Urda, V., Toquero-Ramos, J. et al. Benefits of cardiac pacing in ICD recipients with hypertrophic cardiomyopathy. J Interv Card Electrophysiol (2021). https://doi.org/10.1007/s10840-021-00961-9

Download citation

Keywords

  • Implantable cardioverter defibrillator
  • Hypertrophic cardiomyopathy
  • Antitachycardia pacing
  • Subcutaneous defibrillator
  • Cardiac pacing
  • Monomorphic ventricular tachycardia