Dual-Chamber Pacing in Obstructive Hypertrophic Cardiomyopathy: Is There Evidence for a Real Benefit?

  • S. B. Betocchi
  • M. A. Losi
  • C. Pappone
  • M. Chiariello
Conference paper


Hypertrophic cardiomyopathy (HCM) is a primary myocardial disease whose typical pathophysiologic features include normal systolic dynamics, impaired diastolic function (1–7), and, in about one fourth of patients, left ventricular (LV) outflow tract obstruction (8–11).


Hypertrophic Cardiomyopathy Leave Ventricular Outflow Tract Obstruction Left Ventricular Relaxation Obstructive Hypertrophic Cardiomyopathy Leave Ventricular Systolic Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Sanderson JE, Gibson DG, Brown DJ, Goodwin JF (1977) Left ventricular filling in hypertrophie cardiomyopathy. Br Heart J 39: 661–670PubMedCrossRefGoogle Scholar
  2. 2.
    Hanrath P, Mathey DG, Siegert R, Bleifeld W (1980) Left ventricular relaxation and filling in different forms of left ventricular hypertrophy: an echocardiographic study. Am J Cardiol 45: 15–23PubMedCrossRefGoogle Scholar
  3. 3.
    Bonow RO, Frederick TM, Bacharach SL, Green MV, Goose PW, Maron BJ, Rosing DR (1983) Atrial systole and left ventricular filling in patients with hypertrophie cardiomyopathy. Am J Cardiol 51: 1386–1991PubMedCrossRefGoogle Scholar
  4. 4.
    Alvares RF, Shaver JA, Gamble WH, Goodwin JF (1984) Isovolumic relaxation period in hypertrophie cardiomyopathy. J Am Coll Cardiol 3: 71–81PubMedCrossRefGoogle Scholar
  5. 5.
    Betocchi S, Bonow RO, Bacharach SL, Rosing DR, Maron BJ, Green MV (1986) lsovolumic relaxation period in hypertrophie cardiomyopathy: assessment by radionuclide angiography. J Am Coll Cardiol 7: 74–81Google Scholar
  6. 6.
    Hess OM, Murakami T, Krayenbuehl HP (1986) Does verapamil improve left ventricular relaxation in patients with myocardial hypertrophy? Circulation 74: 530–543PubMedCrossRefGoogle Scholar
  7. 7.
    Hess OM, Grimm J, Krayenbuehl HP (1983) Diastolic function in hypertrophie cardiomyopathy: effects of propranolol and verapamil on diastolic stiffness. Eur Heart J 4 [Suppl F]: 47–56PubMedGoogle Scholar
  8. 8.
    Maron BJ, Gottdiener JS, Arce J, Rosing DR, Wesley YE, Epstein SE (1985) Dynamic subaortic obstruction in hypertrophie cardiomyopathy: analysis by pulsed Doppler echocardiography. J Am Coll Cardiol 6: 1–15PubMedCrossRefGoogle Scholar
  9. 9.
    Maron BJ, Epstein SE (1986) Clinical significance and therapeutic implications of the left ventricular outflow tract pressure gradient in hypertrophie cardiomyopathy. Am J Cardiol 58: 1093–1096PubMedCrossRefGoogle Scholar
  10. 10.
    Seiler C, Hess OM, Schoenbeck M, Turina J, Jenni R, Turina M, Krayenbuehl HP (1991) Long-term follow-up of medical versus surgical therapy for hypertrophie cardiomyopathy: a retrospective study. J Am Coll Cardiol 17: 634–642PubMedCrossRefGoogle Scholar
  11. 11.
    Kaltenbach M, Hopf R, Kober G, Bussman WD, Keller M, Paterson Y (1979) Treatment of hypertrophie cardiomyopathy with verapamil. Br Heart J 42: 35–42PubMedCrossRefGoogle Scholar
  12. 12.
    Morrow AG, Fogarty TJ, Hannah H III, Braunwald E (1968) Operative treatment in idiopathic hypertrophie subaortic steno-sis: techniques and the results of preoperative and postoperative clinical and hemodynamic assessment. Circulation 37: 589–596PubMedGoogle Scholar
  13. 13.
    Hassenstein P, Walther H, Dittrich J (1975) Haemodynamische Veranderungen durch einfach und gekoppelte Stimulation bei Patienten mit obstruktiver Kardiomyopathie. Verh Dtsch Ges Inn Med 81: 170–173PubMedGoogle Scholar
  14. 14.
    Duck HJ, Hutschemeister W, Paneau H, Trenckmann H (1984) Atrio-ventricular stimulation with reduced AV-delay time as a therapeutic principle in hypertrophie obstructive cardiomyopathy. Z Ges Inn Med 39: 437–447PubMedGoogle Scholar
  15. 15.
    McDonald K, McWilliam E, O’Keeffe B, Maurer B (1988) Functional assessment of patients treated with permanent dual chamber pacing as a primary treatment for hypertrophie cardiomyopathy. Eur Heart J 9: 893–898PubMedGoogle Scholar
  16. 16.
    Fananapazir L, Cannon RO III, Tripodi D, Panza JA (1992) Impact of dual-chamber permanent pacing in patients with obstructive hypertrophie cardiomyopathy with symptoms refractory to verapamil and ß-adrenergic blocker therapy. Circulation 85: 2149–2161PubMedGoogle Scholar
  17. 17.
    Jeanrenaud X, Goy JJ, Kappenberger L (1992) Effects of dual-chamber pacing in hypertrophie obstructive cardiomyopathy. Lancet 339: 1318–1323PubMedCrossRefGoogle Scholar
  18. 18.
    Betocchi S, Losi MA, Franculli F, Perrone-Filardi P, Russolillo E, Piscione F (1993) Dual chamber pacing in hypertrophie cardiomyopathy: impact of atrio-ventricular coupling on left ventricular obstruction. Circulation 88: 1–210 (abstr)Google Scholar
  19. 19.
    Losi MA, Betocchi S, Briguori C, Manganelli F, Stabile G, Franculli F, Pappone C, Chiariello M (1995) Hypertrophie cardiomyopathy and dual chamber pacing: impact of atrio-ventricular delay on obstruction assessed by Doppler echocardiography. J Am Coll Cardiol 25: 234-A (abstr)Google Scholar
  20. 20.
    Betocchi S, Losi MA, Piscione F, Russolillo E, Perrone-Filardi P, Pace L, Boccalatte M, Salvatore M, Chiariello M (1994) Atrio-ventricular pacing relieves obstruction but impairs diastolic function in hypertrophie cardiomyopathy. J Am Coll Cardiol 23: 11-A (abstr)Google Scholar
  21. 21.
    Zile MR, Blaunstein AS, Shimizu G, Gaasch WH (1987) Right ventricular pacing reduces the rate of left ventricular relaxation and filling. J Am Coll Cardiol 10: 702–709PubMedCrossRefGoogle Scholar
  22. 22.
    Aoyagy T, Iizuka M, Takahashi K, Ohya T, Serizawa T, Momomura S, Satoh H, Mochizuki T, Matsui H, Ikenouchi H, Shin I, Ma YX, Sugimoto T (1989) Wall motion asynchrony prolongs time-constant of left ventricular relaxation. Am J Physiol 257: H883 - H890Google Scholar
  23. 23.
    Bedotto JB, Grayburn PA, Black WH, Raya TE, McBride W, Hsia HH (1990) Alteration in left ventricular relaxation during atrioventricular pacing in humans. J Am Coll Cardiol 15: 658–664PubMedCrossRefGoogle Scholar
  24. 24.
    Betocchi S, Piscione F, Villari B, Pace L, Ciarmiello A, Perrone-Filardi P, Salvatore C, Salvatore M, Chiariello M (1993) Effects of induced asynchrony on left ventricular diastolic function in patients with coronary artery disease. J Am Coll Cardiol 21: 1124–1131PubMedCrossRefGoogle Scholar
  25. 25.
    Gaasch WH, Blaunstein AS, Andrias CW, Donahue RP, Avi-tall B (1980) Myocardial relaxation. II. Hemodynamic determinants of rate of left ventricular isovolumic pressure decline. Am J Physiol 239: Hl-H6Google Scholar
  26. 26.
    Ishida Y, Meisner JS, Tsujoka K, Gallo JI, Yoran C, Frater RWM, Yellin EL (1986) Left ventricular filling dynamics: influence of left ventricular relaxation and left atrial pressure. Circulation 74: 187–196PubMedCrossRefGoogle Scholar
  27. 27.
    Fananapazir L, Epstein ND, Curie] RV, Panza J, Tripodi D, McAreavey D (1994) Long-term results of dual-chamber (DDD) pacing in obstructive hypertrophie cardiomyopathy. Evidence for progressive symptomatic and hemodynamic improvement and reduction of left ventricular hypertrophy. Circulation 90: 2731–2742PubMedGoogle Scholar
  28. 28.
    Posma JL, Blanksma PK, Haagen FDM, Vaalburg W, Lie KI (1995) Effects of dual chamber pacing on myocardial ischemia in hypertrophie cardiomyopathy studied with 13N ammonia and 18FDG positron emission tomography. J Am Coll Cardiol 25: 30-A (abstr)Google Scholar
  29. 29.
    Sadoul N, Slade AKB, Simon JP, Saumarez RC, Dodinot B, Allot E, McKenna WJ (1995) Dual chamber pacing in refractory hypertrophie obstructive cardiomyopathy: a two-center european experience in 34 consecutive patients. J Am Coll Cardiol 25: 233-A (abstr)Google Scholar
  30. 30.
    McAreavey D, Fananapazir L (1995) Long term results of dual chamber (DDD) pacing in 114 adult patients with obstructive hypertrophie cardiomyopathy and severe drug-refractory symptoms. J Am Coll Cardiol (abstr) 25: 233-AGoogle Scholar
  31. 31.
    Nishimura RA, Trusty JM, Hayes DL, Allison TG, Holmes DR, Hayes SH, Espinosa RE, Symanski JD, Tajik J (1995) Dual-chamber pacing for patients with hypertrophie obstructive cardiomyopathy: a prospective randomized, double-blind crossover trial. J Am Coll Cardiol 25: 10-A (abstr)Google Scholar

Copyright information

© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • S. B. Betocchi
    • 1
  • M. A. Losi
    • 1
  • C. Pappone
    • 1
  • M. Chiariello
    • 1
  1. 1.Dipartimento di Cardiologia e CardiochirurgiaUniversità Federico IINaplesItaly

Personalised recommendations