Significant improvement of quality of life following atrioventricular synchronous pacing in patients with hypertrophic obstructive cardiomyopathy. Data from 1 year of follow-up

Aims Atrioventricular synchronous pacing exerts beneficial effects, including reduction of left ventricular outflow tract gradients, in patients with hypertrophic obstructive cardiomyopathy. The Pacing in Cardiomyopathy study was initiated to explore the effects of pacing in a double-blind randomize...

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Published in:	European heart journal Vol. 20; no. 14; pp. 1044 - 1050
Main Authors:	Gadler, F., Linde, C., Daubert, C., McKenna, W., Meisel, E., Aliot, E., Chojnowska, L., Guize, L., Gras, D., Jeanrenaud, X., Kappenberger, L., PIC study group
Format:	Journal Article
Language:	English
Published:	Oxford Oxford University Press 01-07-1999
Subjects:	Biological and medical sciences Cardiology. Vascular system Heart hypertrophic obstructive cardiomyopathy Medical sciences Myocarditis. Cardiomyopathies Pacing quality of life Human Instrumental stimulation Prognosis Treatment Pacemaker Heart disease Instrumentation therapy Cardiovascular disease Obstructive hypertrophic cardiomyopathy Myocardial disease Quality of life
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Summary:	Aims Atrioventricular synchronous pacing exerts beneficial effects, including reduction of left ventricular outflow tract gradients, in patients with hypertrophic obstructive cardiomyopathy. The Pacing in Cardiomyopathy study was initiated to explore the effects of pacing in a double-blind randomized crossover fashion. The aims were to ascertain the beneficial effects of pacing in a controlled study and to rule out a placebo effect by pacing. This paper deals with the outcome of pacing on quality of life during 1 year of follow-up. Methods Quality of life was evaluated with the Karolinska questionnaire, validated for patients paced for bradyarrhythmias and ischaemic heart disease. Drug-refractory patients with hypertrophic obstructive cardiomyopathy were recruited for the study and after a temporary pacing procedure implanted with permanent pacemakers. Patients were randomized to two study arms defining the sequence of pacemaker programming. In one arm the pacemaker was inactive, in the other active. After 3 months the pacemaker was reprogrammed to the alternate mode and a further 3 months followed. After this period subsequent pacemaker programming corresponded to the mode preferred by the patient. A last assessment was made 1 year after baseline examinations. Results Eighty patients completed the first crossover period and 75 completed the full 1 year of follow-up. Active pacing induced significant quality of life improvements, in the order of 9–44%, regardless of programming sequence. Discontinuation of pacing after a first active period resulted in the return of symptoms. Fourteen patients requested early reprogramming after having been programmed to inactive pacing after a first period of active pacing. Seventy-six patients preferred active pacing after the crossover period. A further 6 months of pacing induced progressive improvement in symptoms already favourably influenced. Conclusion Atrioventricular synchronous pacing has a profound beneficial effect on most domains of quality of life in patients with hypertrophic obstructive cardiomyopathy refractory to drug treatment.
Bibliography:	local:0.98913318.1044 ark:/67375/HXZ-5P24123L-9 istex:3CEA7734546C1A67FB405156FF4B43BBA23EED85
ISSN:	0195-668X 1522-9645
DOI:	10.1053/euhj.1998.1331