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Benefits of cardiac pacing in ICD recipients with hypertrophic cardiomyopathy

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Implantable cardiac defibrillator (ICD) is the only definitive therapy for prevention of sudden cardiac death in hypertrophic cardiomyopathy (HCM). Conventional transvenous ICDs can provide cardiac pacing unlike new subcutaneous ICD, but the usefulness of cardiac pacing in HCM patients is not well defined. We sought to assess the usefulness of ICD pacing in HCM.

Methods

We retrospectively analyzed 93 HCM patients who had undergone ICD implantation at our center. Usefulness of pacing was defined as follows: 1) need of pacing due to bradycardia or AV conduction disturbances, 2) improvement of LV outflow tract obstruction by sequential AV pacing, 3) need for CRT pacing, or 4) successful antitachycardia pacing without a subsequent shock. Independent predictors of useful pacing were investigated by multivariable analysis.

Results

During a mean follow-up of 91.3 ± 5.5 months, 43 patients (46.2%) reached the composite endpoint. Independent predictors of pacing usefulness were older age (HR 1.36; 95%CI: 1.088–1.709; p=0.007) and NYHA functional class ≥ II (HR 2.15; 95%CI: 1.083–4.301; p=0.029). Twenty-eight (30.1%) patients had appropriate ICD interventions, triggered by a monomorphic ventricular tachycardia (MVT) in 22 of them (78.5%). In 17 individuals with MVT (77%), antitachycardia pacing successfully treated MVT.

Conclusions

In our HCM series of patients with ICD, 46% of individuals benefitted from cardiac pacing. MVT were documented in nearly 80% of the patients with ventricular arrhythmias and antitachycardia pacing successfully treated them in 77% of cases.

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Authors and Affiliations

  1. Electrophysiology Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Calle Manuel de Falla 1, 28222 Majadahonda, Madrid, Spain

    Diego Jiménez-Sánchez, Víctor Castro-Urda, Jorge Toquero-Ramos, Manuel Sánchez-García, Eusebio García-Izquierdo, Darwin Veloza, Jorge Baena-Herrera & Ignacio Fernández-Lozano

  2. Heart failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Calle Manuel de Falla 1, 28222 Majadahonda, Madrid, Spain

    María Alejandra Restrepo-Córdoba, Esther González-López, Fernando Domínguez & Pablo García-Pavía

  3. CIBERCV, Madrid, Spain

    Esther González-López, Fernando Domínguez, Pablo García-Pavía & Ignacio Fernández-Lozano

  4. Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, Spain

    Pablo García-Pavía

Authors
  1. Diego Jiménez-Sánchez
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  2. Víctor Castro-Urda
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  3. Jorge Toquero-Ramos
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  12. Ignacio Fernández-Lozano
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Corresponding author

Correspondence to Diego Jiménez-Sánchez.

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Conflict of interest

J.T.R. is a member of the Medtronic European Advisory Board. Has received training course fees from Medtronic, Abbott, and Boston. All other authors did not have a conflict of interest to declare.

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Jiménez-Sánchez, D., Castro-Urda, V., Toquero-Ramos, J. et al. Benefits of cardiac pacing in ICD recipients with hypertrophic cardiomyopathy. J Interv Card Electrophysiol 63, 165–174 (2022). https://doi.org/10.1007/s10840-021-00961-9

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  • DOI: https://doi.org/10.1007/s10840-021-00961-9

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