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Multicenter study of the efficacy and safety of disopyramide in obstructive hypertrophic cardiomyopathy.

Authors :
Sherrid MV
Barac I
McKenna WJ
Elliott PM
Dickie S
Chojnowska L
Casey S
Maron BJ
Source :
Journal of the American College of Cardiology [J Am Coll Cardiol] 2005 Apr 19; Vol. 45 (8), pp. 1251-8.
Publication Year :
2005

Abstract

Objectives: In this study we assessed the long-term efficacy and safety of disopyramide for patients with obstructive hypertrophic cardiomyopathy (HCM).<br />Background: It has been reported that disopyramide may reduce left ventricular outflow gradient and improve symptoms in patients with HCM. However, long-term efficacy and safety of disopyramide has not been shown in a large cohort.<br />Methods: Clinical and echocardiographic data were evaluated in 118 obstructive HCM patients treated with disopyramide at 4 HCM treatment centers. Mortality in the disopyramide-treated patients was compared with 373 obstructive HCM patients not treated with disopyramide.<br />Results: Patients were followed with disopyramide for 3.1 +/- 2.6 years; dose 432 +/- 181 mg/day (97% also received beta-blockers). Seventy-eight patients (66%) were maintained with disopyramide without the necessity for major non-pharmacologic intervention with surgical myectomy, alcohol ablation, or pacing; outflow gradient at rest decreased from 75 +/- 33 to 40 +/- 32 mm Hg (p < 0.0001) and mean New York Heart Association functional class from 2.3 +/- 0.7 to 1.7 +/- 0.6 (p < 0.0001). Forty other patients (34%) could not be satisfactorily managed with disopyramide and required major invasive interventions because of inadequate symptom and gradient control or vagolytic side effects. All-cause annual cardiac death rate between disopyramide and non-disopyramide-treated patients did not differ significantly, 1.4% versus 2.6%/year (p = 0.07). There was also no difference in sudden death rate, 1.0%/year versus 1.8%/year (p = 0.08).<br />Conclusions: Two-thirds of obstructed HCM patients treated with disopyramide could be managed medically with amelioration of symptoms and about 50% reduction in subaortic gradient over >/=3 years. Disopyramide therapy does not appear to be proarrhythmic in HCM and should be considered before proceeding to surgical myectomy or alternate strategies.

Details

Language :
English
ISSN :
0735-1097
Volume :
45
Issue :
8
Database :
MEDLINE
Journal :
Journal of the American College of Cardiology
Publication Type :
Academic Journal
Accession number :
15837258
Full Text :
https://doi.org/10.1016/j.jacc.2005.01.012