Abstract
Clinical improvement with dual-chamber pacing has largely been reported in patients with drug-resistant hypertrophic obstructive cardiomyopathy (HOLM)1–5. This clinical improvement is mainly related to the ability to bypass the normal atrioventricular (AV) conduction system in order to obtain a complete and permanent right ventricular capture. Some patients, however, experience only minor benefits with DDD pacing. This lack of improvement is probably due to incomplete right ventricular capture and/or deleterious effects of short AV delays on AV synchrony and left ventricular filling. Instrumental AV node modulation or ablation may be indicated in this subgroup of patients. Another indication of AV node ablation in HOCM is the occurrence of atrial fibrillation in order to restore adequate and permanent right ventricular capture. This chapter will focus on the rationale, the technical problems and results of AV node ablation in HOCM.
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References
Erwin J, McWilliams E, Gearty G, Maurer D. Dual chamber pacing — an effective treatment for hypertrophie cardiomyopathy. PACE 1985;8:A–34 (abstract).
McDonald K, McWilliams E, O’Keeffe B, Maurer D. Functional assessment of patients treated with permanant dual-chamber pacing as a primary treatment for hypertrophic cardiomyopathy. Eur Heart J 1988;9:893–8.
Jeanrenaud X, Goy JJ, Kappenberger L. Effects of dual chamber pacing in hypertrophie obstructive cardiomyopathy. Lancet 1992;339:1318–23.
Fananapazir L, Cannon RO, Tripodi D, Panza JA. Impact of dual-chamber pacing in patients with hypertrophie cardiomyopathy with symptoms refractory to verapamil and β-adrenergic blocker therapy. Circulation 1992; 85:2149–61.
Daubert JC. Pacing and hypertrophie obstructive cardiomyopathy. PACE 1996;19:1141–2.
Maron B, Bonow R, Cannon R, Leon M, Epstein S. Hypertrophie cardiomyopathy. interrelation of clinical manifestations, pathophysiology and therapy (first of two parts). N Engl J Med 1987;316:780–9.
Sadoul N, Simon JP, De Chillou C et al. Intérêts de la stimulation cardiaque permanente dans les myocardiopathies hypertrophiques et obstructives rebelles au traitement médical. Arch Mal Coeur 1994;87:1315–23.
McAreavey D, Tripodi D, Epstein N, Fananapazir L. Dual chamber pacing relieves outflow tract obstruction and improves symptoms in hypertophic cardiomyopathy patients despite pre-existing left bundle branch block. J Am Coll Cardiol 1993;21:123A (abstract).
Xiao HB, Brecker SJD, Gibson DJ. Differing effects of right ventricular pacing and left bundle branch block on left ventricular function. Br Heart J 1993;69:166–73.
Nishimura RA, Danielson GK. Dual chamber pacing for hypertrophie obstructive cardiomyopathy: has it come? Br Heart J 1993;70:301–3.
Jeanrenaud X, Sadoul N, Simon JP et al for the PIC (Pacing in Cardiomyopathy) group study. Multicenter European experience on permanent pacing for hypertrophia obstructive cardiomyopathy. Eur Heart J 1993; 14:270 (abstract).
Gras D, Leclercq C, Baïsset JM, Paillard F, Mabo P, Daubert C. Is benefit of DDD pacing in obstructive hypertrophic cardiomyopathy due to the possibility of optimizing drug therapy? Circulation 1994;90:I–443 (abstract).
Duckeck W, Engelstein ED, Kuck KH. Radiofrequency current therapy in atrial tachyarrhythmias: modulation versus ablation of atrioventricular nodal conduction. PACE 1993;16:629–36.
Langberg JJ. Radiofrequency catheter ablation of AV nodal reentry: the anterior approach. PACE 1993; 16:615–22.
Sadoul N, Dodinot B, Beurrier D, de Chillou C, Aliot E. Atrioventricular node ablation for optimization of pacemaker treatment in hypertrophic obstructive cardiomyopathy. J Interven Cardiol 1996;9:347–53.
Haissaguerre M, Warin JF, Lemetayer P et al. Closed-chest ablation of retrograde conduction in patients with atrioventricular nodal reentrant tachycardia. N Engl J Med 1989;320:426–32.
Gras D, de Place C, Le Breton H, et al. L’importance du synchronisme auriculo-ventriculaire dans la myocardiopathie hypertrophique obstructive traitée par stimulation cardiaque. Arch Mal Coeur 1995;88:215–23.
Gras D, Pavin D, Leclercq C, Baïsset JM, Mabo P, Daubert C. Major benefit of AV junction radiofrequency ablation in selected patients with hypertrophic obstructive cardiomyopathy treated by DDD pacing. Circulation 1995;92:I–203 (abstract).
Jeanrenaud X, Schlaepfer J, Fromer M, Aebischer N, Kappenberger L. Dual chamber pacing in hypertrophic obstructive cardiomyopathy: beneficial effect of atrioventricular junction ablation for optimal left ventricular capture and filling. PACE 1997;20: 293–300.
Fananapazir L, Epstein N, Curiel R et al. 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. Circulation 1994; 90:2731–42.
Chang AC, Bartlett T, McAreavey D, Tripodi D, Fananapazir L. Atrioventricular node ablation coupled with rate responsive ventricular demand pacing improves symptoms and hemodynamics in patients with hypertrophic cardiomyopathy. Circulation 1992;86(Suppl. I): 1–273 (abstract).
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Sadoul, N., Dodinot, B., Beurrier, D., de Chillou, C., Aliot, E. (1998). AV Node Ablation and DDD Pacing in Hypertrophic Obstructive Cardiomyopathy. In: Vardas, P.E. (eds) Cardiac Arrhythmias, Pacing & Electrophysiology. Developments in Cardiovascular Medicine, vol 201. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-5254-9_62
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DOI: https://doi.org/10.1007/978-94-011-5254-9_62
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