A resposta ventricular evocada nos pacientes com miocardiopatia hipertrofica obstrutiva tratada por marcapasso DDD

• Autor(a) principal: Sant'Anna, João Ricardo Michielin
• Data de Publicação: 1999
• Outros Autores: Prati, Raquel, Hutten, Helmut, Schreier, Gunter, Kastner, Peter, Kalil, Renato Abdala Karam, Prates, Paulo Roberto Lunardi, Castro, Iran, Azambuja, Paulo C., Faes, Farid Cézar, Nesralla, Ivo Abrahao, Schaldach, Max
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UFRGS
• Texto Completo: http://hdl.handle.net/10183/19313
• topic: Cardiomiopatia hipertrófica; Marca-passo artificial; Obstructive hypertrophic cardiomyopathy; DDD pacing intracardiac electrogram

Objective - To assess the changes in ventricular evoked responses (VER) produced by the decrease in left ventricular outflow tract gradient (LVOTG) in patients with hypertrophic obstructive cardiomyopathy (HOCM) treated with dual-chamber (DDD) pacing. Methods - A pulse generator Physios CTM (Biotronik, Germany) was implanted in 9 patients with severe drug-refractory HOCM. After implantation, the following conditions were assessed: 1) Baseline evaluation: different AV delay (ranging from 150ms to 50 ms) were sequentially programmed during 5 to 10 minutes, and the LVOTG (as determined by Doppler echocardiography) and VER recorded; 2) standard evaluation, when the best AV delay (resulting in the lowest LVOTG) programmed at the initial evaluation was maintained so that its effect on VER and LVOTG could be assessed during each chronic pacing evaluation. Results - LVOTG decreased after DDD pacing, with a mean value of 59 ± 24 mmHg after dual chamber pacemaker, which was significantly less than the gradient before pacing (98 + 22mmHg). An AV delay >100ms produced a significantly lower decrease in VER depolarization duration (VERDD) when compared to an AV delay £100ms. Linear regression analyses showed a significant correlation between the LVOTG values and the magnitude of VER (r=0.69; p<0.05) in the 9 studied patients. Conclusion - The telemetry obtained intramyocardial electrogram is a sensitive means to assess left ventricular dynamics in patients with HOCM treated with DDD pacing.