PMID- 25623178 OWN - NLM STAT- MEDLINE DCOM- 20160204 LR - 20161222 IS - 1556-3871 (Electronic) IS - 1547-5271 (Linking) VI - 12 IP - 5 DP - 2015 May TI - Optimized pacing mode for hypertrophic cardiomyopathy: Impact of ECG fusion during pacing. PG - 909-16 LID - S1547-5271(15)00082-X [pii] LID - 10.1016/j.hrthm.2015.01.032 [doi] AB - BACKGROUND: Electrocardiographic (ECG) fusion with intrinsic QRS could reduce the benefit of atrial synchronous biventricular pacing (AS-BiVP) in patients with hypertrophic obstructive cardiomyopathy (HOCM). OBJECTIVES: The purpose of this study was to assess the benefit of AS-BiVP and the influence of ECG fusion for reduction of left ventricular outflow tract gradient (LVOTG) in these patients. METHODS: Twenty-one symptomatic HOCM patients with severe LVOTG were included. Twelve patients were evaluated retrospectively for the prevalence of fusion and its influence on outcomes after AS-BiVP. Eleven patients (2 of the first population were also evaluated retrospectively) were prospectively included to evaluate the benefit of performing atrioventricular node ablation (AVNA) to achieve full ventricular capture if fusion was present during AS-BiVP. RESULTS: Seven of the first 12 patients (58%) had ECG fusion. After 54 +/- 24 months of AS-BiVP, the presence of fusion was associated with lower values for reduction of resting, dynamic LVOTG and New York Heart Association (NYHA) class. In the prospectively evaluated patients, after 12 months of follow-up, resting LVOTG decreased from 98 +/- 39 to 39 +/- 24 mm Hg (P = .008); dynamic LVOTG decreased from 112 +/- 38 to 60 +/- 24 mm Hg (P = .013); NYHA class decreased from 2.8 +/- 0.4 to 1.7 +/- 0.6 (P = .014); endurance time during constant work rate cycling exercise (80% of peak oxygen consumption) increased from 399 +/- 148 to 691 +/- 249 seconds (P = .046); quality of life improved from 46 +/- 22 to 22 +/- 20 points (P = .02); and brain natriuretic peptide levels decreased from 318 +/- 238 to 152 +/- 118 pg/mL (P = .09). Eight of the 11 prospectively evaluated patients (73%) needed AVNA, which further decreased LVOTG from 108 +/- 40 mm Hg at baseline to 89 +/- 29 mm Hg after BiVP to 54 +/- 22 mm Hg after AVNA (P = .003). CONCLUSION: As-BiVP that ensures no ECG fusion, by means of AVNA when needed, appears to be the optimal pacing mode in HOCM patients. CI - Copyright (c) 2015. Published by Elsevier Inc. FAU - Berruezo, Antonio AU - Berruezo A AD - Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain. Electronic address: berruezo@clinic.ub.es. FAU - Penela, Diego AU - Penela D AD - Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain. FAU - Burgos, Felip AU - Burgos F AD - Pneumology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain; Centro de Investigacion en Red de Enfermedades Respiratorias (CibeRes), Palma de Mallorca, Spain. FAU - Evertz, Reinder AU - Evertz R AD - Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain. FAU - Fernandez-Armenta, Juan AU - Fernandez-Armenta J AD - Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain. FAU - Roca, Josep AU - Roca J AD - Pneumology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain; Centro de Investigacion en Red de Enfermedades Respiratorias (CibeRes), Palma de Mallorca, Spain. FAU - Doltra, Ada AU - Doltra A AD - Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain. FAU - Acosta, Juan AU - Acosta J AD - Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain. FAU - Francino, Antonio AU - Francino A AD - Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain. FAU - Sitges, Marta AU - Sitges M AD - Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain. FAU - Alsina, Xavi AU - Alsina X AD - Pneumology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain. FAU - Ordonez, Augusto AU - Ordonez A AD - Cardiology Department, Hospital Sant Pau I Santa Tecla, Tarragona, Catalonia, Spain. FAU - Villuendas, Roger AU - Villuendas R AD - Arrhythmia Section, Cardiology Department, Hospital Germans Trias i Pujol de Badalona, Catalonia, Spain. FAU - Brugada, Ramon AU - Brugada R AD - Department of Medical Sciences, University of Girona, Catalonia, Spain and Cardiology Service, Hospital Josep Trueta, Girona, Catalonia, Spain. FAU - Mont, Lluis AU - Mont L AD - Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain. FAU - Brugada, Josep AU - Brugada J AD - Cardiology Department, Thorax Institute, Hospital Clinic, University of Barcelona, Catalonia, Spain. LA - eng PT - Journal Article DEP - 20150123 PL - United States TA - Heart Rhythm JT - Heart rhythm JID - 101200317 SB - IM MH - *Ablation Techniques/adverse effects/methods MH - Adult MH - Aged MH - *Atrioventricular Node/physiopathology/surgery MH - Cardiac Resynchronization Therapy/*methods MH - *Cardiomyopathy, Hypertrophic, Familial/complications/diagnosis/physiopathology/surgery MH - Echocardiography, Doppler, Color/methods MH - Electrocardiography/methods MH - Female MH - Humans MH - Male MH - Middle Aged MH - Retrospective Studies MH - Severity of Illness Index MH - Spain MH - Treatment Outcome MH - *Ventricular Outflow Obstruction/diagnosis/etiology/surgery OTO - NOTNLM OT - Atrioventricular node ablation OT - Biventricular stimulation OT - Hypertrophic cardiomyopathy OT - Left ventricular outflow tract gradient OT - Pacing EDAT- 2015/01/28 06:00 MHDA- 2016/02/05 06:00 CRDT- 2015/01/28 06:00 PHST- 2014/12/04 00:00 [received] PHST- 2015/01/28 06:00 [entrez] PHST- 2015/01/28 06:00 [pubmed] PHST- 2016/02/05 06:00 [medline] AID - S1547-5271(15)00082-X [pii] AID - 10.1016/j.hrthm.2015.01.032 [doi] PST - ppublish SO - Heart Rhythm. 2015 May;12(5):909-16. doi: 10.1016/j.hrthm.2015.01.032. Epub 2015 Jan 23.