Dual-chamber pacing and alcohol septal ablation in hypertrophic obstructive cardiomyopathy - results of long-term follow-up

Background: Hypertrophic obstructive cardiomyopathy patients with drug-refractory symptoms could be treated non-pharmacologically by alcohol septal ablation (ASA) and dual-chamber (DDD) pacing. ASA is the most frequently used intervention; DDD pacing is currently used rather exceptionally. However, data from long-term follow up of pacing treated patients show a more pronounced effect than described previously. Aim of the study: To compare the long-term effect of DDD pacing and ASA in the treatment of obstructive hypertrophic cardiomyopathy (HCM). Methods: There were included 24 HCM patients treated with DDD pacing and 52 treated with ASA, who were followed for 101±49 and 87±23 months, respectively. Changes in echocardiographic parameters and functional status of the patients were compared. Results: In the group treated with DDD pacing the left ventricle outflow tract gradient (LVOTG) decreased from 82±44 mmHg to 21±21 mmHg, and NYHA class improved from 2.7±0.5 to 2.1±0.6 (both p < 0.001). In the ASA-treated group a decline in LVOTG from 73±38 mmHg to 24±26 mmHg and reduction in NYHA class from 2.8±0.5 to 1.7±0.8 (both p < 0.001) was observed. The LVOTG change was similar in both groups (p = 0.260), symptoms were more affected by ASA (p = 0.001). Conclusion: ASA and DDD pacing were similarly effective in reducing LVOTG. The symptoms improvement was more pronounced in patients treated with ASA.