Search

Objectives: To investigate cardiac implantable electrical device (CIED) first implants in patients with hypertrophic cardiomyopathy (HCM) in a Swedish tertiary university hospital. Design: Clinical and technical data on pacemaker, implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy (CRT) first implants performed in HCM patients at the Karolinska University Hospital from 2005 to 2016 were extracted from the Swedish Pacemaker and ICD Registry. Echocardiographic data were obtained by review of hospital recordings. Results: The number of first pacemaker implants in HCM patients was 70 (1.5% of total pacemaker implants). The mean age of HCM pacemaker patients was 71 ± 10 years. Pacemaker implants were almost uniformly distributed between genders. Dual-chamber pacemakers with or without CRT properties were prevalent (6 and 93%, respectively). The number of first ICD implants in HCM patients was 99 (5.1% of total ICD implants). HCM patients receiving an ICD were 53 ± 15 years and prevalently men (70%). Sixty-five (66%) patients were implanted for primary prevention. Dual-chamber ICDs with or without CRT were 21 and 65%, respectively. Obstructive HCM was present in 47% pacemaker patients and 25% ICD patients with available pre-implant echo. Conclusions: This retrospective registry-based study provides a picture of CIED first implants in HCM patients in a Swedish tertiary university hospital. ICDs were the most commonly implanted devices, covering 59% of CIED implants. HCM patients receiving a pacemaker or an ICD had different epidemiological and clinical profiles. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is considered as an epidemic and affects 2% of the population in the Western world. About 15 30% of patients with HF and reduced ejection fraction (HFrEF) also have prolonged QRS duration on the surface ECG, most commonly as a result of left bundle branch block (LBBB). Increased QRS duration is a marker of a dyssynchronous activation, and subsequent contraction, pattern in the left ventricle (LV). When dyssynchrony is superimposed on the failing heart it further reduced systolic function and ultimately worsens outcome. During the past 15 years several randomized controlled clinical trials have documented that resynchronization of the dyssynchronous failing heart with a biventricular pacemaker cardiac resynchronization therapy (CRT) which can restore a more synchronous activation and contraction pattern. This translates in halted or reversed disease progression and improved clinical outcome, including reduced mortality. In this review, we will discuss several aspects of CRT including mechanisms of dyssynchrony and resynchronization in the failing heart, evidence of CRT efficacy derived from clinical trials and current challenges in CRT including patient selection and optimization of therapy delivery. Last, we will discuss future perspectives including the role of CRT to prevent adverse events in patients with an indication for antibradycardia pacing, the role of leadless pacing in the CRT setting as well as a new clinical arena where dyssynchrony and resynchronization may be important. [ABSTRACT FROM AUTHOR]