CLINICAL STUDIES
Comparison of dual-chamber pacing versus septal myectomy for the treatment of patients with hypertrophic obstructive cardiomyopathy1
A comparison of objective hemodynamic and exercise end points
Steve R. Ommen, MD*,
Rick A. Nishimura, MD, FACC*,
Ray W. Squires, PhD*,
Hartzell V. Schaff, MD, FACC ,
Gordon K. Danielson, MD, FACC and
A. Jamil Tajik, MD, FACC*
* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Manuscript received September 2, 1998;
revised manuscript received February 24, 1999,
accepted March 26, 1999.
Reprint requests and correspondence: Dr. Rick A. Nishimura, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905
OBJECTIVES
The purpose of this study was to compare the treatment effects of septal myectomy with dual-chamber pacing in patients with hypertrophic obstructive cardiomyopathy (HOCM).
BACKGROUND
The optimal treatment for symptomatic patients with drug-refractory HOCM is unknown. Both dual-chamber pacing and surgical myectomy may result in subjective symptom improvement. However, no direct comparisons with objective end points have been reported.
METHODS
Thirty-nine patients with symptomatic HOCM were analyzed in this concurrent cohort study. Twenty patients underwent surgical myectomy, and 19 received dual-chamber pacemakers based on patient preference. These patients had prospective baseline and follow-up evaluations including physician assessment, echocardiography and standardized metabolic treadmill exercise testing.
RESULTS
Baseline symptom status, left ventricular outflow tract gradients, exercise times and maximal oxygen consumption peak were similar between the two groups. Left ventricular outflow gradient was reduced from 76 ± 57 to 9 ± 17 mm Hg (p = 0.0001) after myectomy, and from 77 ± 61 to 55 ± 39 mm Hg (p = 0.07) after pacing (p = 0.02 for comparison with myectomy). Ninety percent of myectomy patients experienced symptomatic improvement as compared with 47% in the pacing group. Exercise duration increased significantly from 6.6 ± 2.8 to 8.7 ± 3.0 min (p = 0.0003) after myectomy compared with a change from 6.4 ± 2.1 to 7.0 ± 2.2 min (p = NS) in the pacing group. Maximal oxygen consumption increased from 19.4 ± 6.4 to 22.2 ± 6.5 ml/kg/min after myectomy (p = 0.004), whereas the pacing group did not experience any significant change (19.6 ± 6.5 vs. 20.1 ± 6.5 ml/kg/min, p = NS).
CONCLUSIONS
Surgical myectomy and dual-chamber pacing improve subjective measures of functional status in patients with symptomatic HOCM. In this nonrandomized study, myectomy offered greater reduction in left ventricular outflow tract gradients and larger improvements in objective measures of patient symptoms and functional status when compared with dual-chamber pacing.
|
Abbreviations and Acronyms
| | HOCM | = hypertrophic obstructive cardiomyopathy | | NYHA | = New York Heart Association | | VO2 peak | = maximal oxygen consumption |
|
This article has been cited by other articles:
|
|
|
|
 
S R Ommen, P M Shah, and A J Tajik
Left ventricular outflow tract obstruction in hypertrophic cardiomyopathy: past, present and future
Heart,
October 1, 2008;
94(10):
1276 - 1281.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Fifer and G. J. Vlahakes
Management of Symptoms in Hypertrophic Cardiomyopathy
Circulation,
January 22, 2008;
117(3):
429 - 439.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al.
Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association
Europace,
October 1, 2007;
9(10):
959 - 998.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, P. E. Vardas, A. Auricchio, J.-J. Blanc, J.-C. Daubert, H. Drexler, H. Ector, M. Gasparini, C. Linde, F. B. Morgado, et al.
Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association
Eur. Heart J.,
September 2, 2007;
28(18):
2256 - 2295.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Maron
Surgical Myectomy Remains the Primary Treatment Option for Severely Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy
Circulation,
July 10, 2007;
116(2):
196 - 206.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Woo, W. G. Williams, R. Choi, E. D. Wigle, E. Rozenblyum, K. Fedwick, S. Siu, A. Ralph-Edwards, and H. Rakowski
Clinical and Echocardiographic Determinants of Long-Term Survival After Surgical Myectomy in Obstructive Hypertrophic Cardiomyopathy
Circulation,
April 26, 2005;
111(16):
2033 - 2041.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. J. Deb, H. V. Schaff, J. A. Dearani, R. A. Nishimura, and S. R. Ommen
Septal Myectomy Results in Regression of Left Ventricular Hypertrophy in Patients With Hypertrophic Obstructive Cardiomyopathy
Ann. Thorac. Surg.,
December 1, 2004;
78(6):
2118 - 2122.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Maron, J. A. Dearani, S. R. Ommen, M. S. Maron, H. V. Schaff, B. J. Gersh, and R. A. Nishimura
The case for surgery in obstructive hypertrophic cardiomyopathy
J. Am. Coll. Cardiol.,
November 16, 2004;
44(10):
2044 - 2053.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A. Nishimura and D. R. Holmes Jr.
Hypertrophic Obstructive Cardiomyopathy
N. Engl. J. Med.,
March 25, 2004;
350(13):
1320 - 1327.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, F. J. Ten Cate, et al.
American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines
J. Am. Coll. Cardiol.,
November 5, 2003;
42(9):
1687 - 1713.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, B. J. Maron, W. J. McKenna, G. K. Danielson, L. J. Kappenberger, H. J. Kuhn, C. E. Seidman, P. M. Shah, W. H. Spencer III, P. Spirito, et al.
American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy: A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines
Eur. Heart J.,
November 1, 2003;
24(21):
1965 - 1991.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. J. Maron
Hypertrophic Cardiomyopathy: A Systematic Review
JAMA,
March 13, 2002;
287(10):
1308 - 1320.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Xin, T. Shiota, H. M. Lever, S. R. Kapadia, M. Sitges, D. N. Rubin, F. Bauer, N. L. Greenberg, D. A. Agler, J. K. Drinko, et al.
Outcome of patients with hypertrophic obstructive cardiomyopathy after percutaneous transluminal septal myocardial ablation and septal myectomy surgery
J. Am. Coll. Cardiol.,
December 1, 2001;
38(7):
1994 - 2000.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. F. Nagueh, S. R. Ommen, N. M. Lakkis, D. Killip, W. A. Zoghbi, H. V. Schaff, G. K. Danielson, M. A. Quinones, A. J. Tajik, and W. H. Spencer III
Comparison of ethanol septal reduction therapy with surgical myectomy for the treatment of hypertrophic obstructive cardiomyopathy
J. Am. Coll. Cardiol.,
November 15, 2001;
38(6):
1701 - 1706.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. D. Wigle, L. Schwartz, A. Woo, and H. Rakowski
To ablate or operate? that is the question!
J. Am. Coll. Cardiol.,
November 15, 2001;
38(6):
1707 - 1710.
[Full Text]
[PDF]
|
|
|
|
