Journal of arrhythmia · 2026
Improvement of Microvascular Ischemia by Atrioventricular Sequential Pacing in Non-Obstructive Hypertrophic Cardiomyopathy.
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Subramanian Muthiah, Manukonda Radhika, Yalagudri Sachin, Saggu Daljeet Kaur, Chennapragda Sridevi, Narasimhan Calambur
Аннотация
BACKGROUND: Therapeutic options for symptomatic non-obstructive hypertrophic cardiomyopathy (nHCM) remain limited. We investigated whether right ventricular apical (RVA) pacing with optimal atrioventricular delay (AVD) can improve myocardial oxygen supply-demand mismatch, assessed using coronary sinus (CS) lactate as a marker of microvascular ischemia.
METHODS: Patients underwent atrial pacing at 70% of target heart rate followed by AV sequential pacing at individually optimized AVD. CS lactate levels were measured at baseline, during atrial pacing, after washout, and during AV sequential pacing.
RESULTS: Baseline CS lactate was 0.55 ± 0.15 mmol/L and increased to 1.13 ± 0.29 mmol/L during atrial pacing. After washout, levels returned to near baseline (0.59 ± 0.21 mmol/L). During AV sequential pacing at optimal AVD (142.8 ± 20.6 ms), CS lactate decreased to 0.86 ± 0.31 mmol/L, showing a significant reduction compared to atrial pacing (p = 0.026). In 15 of 18 patients, CS lactate decreased during AV pacing compared with atrial pacing.
CONCLUSIONS: AV sequential pacing at optimized AVD reduces CS lactate during exertion in most patients with nHCM, suggesting improved myocardial oxygen balance and reduced microvascular ischemia.
METHODS: Patients underwent atrial pacing at 70% of target heart rate followed by AV sequential pacing at individually optimized AVD. CS lactate levels were measured at baseline, during atrial pacing, after washout, and during AV sequential pacing.
RESULTS: Baseline CS lactate was 0.55 ± 0.15 mmol/L and increased to 1.13 ± 0.29 mmol/L during atrial pacing. After washout, levels returned to near baseline (0.59 ± 0.21 mmol/L). During AV sequential pacing at optimal AVD (142.8 ± 20.6 ms), CS lactate decreased to 0.86 ± 0.31 mmol/L, showing a significant reduction compared to atrial pacing (p = 0.026). In 15 of 18 patients, CS lactate decreased during AV pacing compared with atrial pacing.
CONCLUSIONS: AV sequential pacing at optimized AVD reduces CS lactate during exertion in most patients with nHCM, suggesting improved myocardial oxygen balance and reduced microvascular ischemia.