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European Heart Journal 1999 20(3):203-210; doi:10.1053/euhj.1998.1234
Copyright © 1999 by the European Society of Cardiology.
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Effects of permanent dual-chamber pacing on mitral regurgitation in hypertrophic obstructive cardiomyopathy

D. Pavinf1, C. de Place, H. Le Breton, C. Leclercq, D. Gras, F. Victor, P. Mabo and DaubertJ.-C.

Department of Cardiology, University Hospital, Rennes, France

Received July 3, 1998; accepted July 12, 1998

Abstract

Aims

To assess the effects of chronic dual-chamber pacing on mitral regurgitation in hypertrophic obstructive cardiomyopathy.

Methods and Results

Twenty-three patients with hypertrophic obstructive cardiomyopathy and mitral regurgi-tation, treated with DDD pacing for 16±14 months, were included in the study. Mitral regurgitation was assessed by Doppler-echocardiography using semi-quantitative analysis (grades I–IV) and by measuring the maximum regurgitant jet area/left atrial area ratio. At the end of follow-up, DDD pacing reduced the outflow gradient from 93±37mmHg to 31±30mmHg (P<0·0001). Nine of the 14 patients who initially had ≥grade II mitral regurgitation improved by at least one grade, two of them exhibiting dramatic improvement (from grade IV and III to grade I). The regurgitant jet area/left atrial area ratio was reduced with DDD pacing from 20±13% to 11±6% (P<0·0001). Patients who had significant mitral regurgitation despite pacing were those whose outflow gradient remained high or those with mitral valve organic abnormalities (mitral annulus calcification or mitral valve prolapse). In the absence of organic abnormalities other than leaflet elongation, there was a significant correlation between the gradient value achieved with DDD pacing and the extent of mitral regurgitation (P<0·05).

Conclusion

In the absence of organic mitral valve abnormalities, DDD pacing reduces in parallel mitral regurgitation and left ventricular outflow gradient. In such patients therefore, significant mitral regurgitation is not a contraindication to pacing.

Key Words: Hypertrophic obstructive cardiomyopathy • Dual-chamber pacing • Mitral regurgitation

f1 Correspondence: Docteur Pavin Dominique, Département de Cardiologie et Maladies Vasculaires, Centre Cardio-Pneumologique, Pontchaillou, CHU, 2 rue Henri Le Guilloux, 35033 Rennes Cedex, France.

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