Improvement of Microvascular Ischemia by Atrioventricular Sequential Pacing in Non-Obstructive Hypertrophic Cardiomyopathy

IF 1.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Arrhythmia Pub Date : 2026-08-03 DOI:10.1002/joa3.70432

Muthiah Subramanian, Radhika Manukonda, Sachin Yalagudri, Daljeet Kaur Saggu, Sridevi Chennapragda, Calambur Narasimhan

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Abstract

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.

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房室序贯起搏对非阻塞性肥厚性心肌病微血管缺血的改善作用。

背景：症状性非阻塞性肥厚性心肌病（nHCM）的治疗选择仍然有限。我们通过冠状动脉窦（CS）乳酸水平作为微血管缺血的标志，研究了最佳房室延迟（AVD）右室尖顶起搏（RVA）是否能改善心肌氧供需错配。方法：患者以目标心率的70%进行心房起搏，然后在单独优化的AVD进行房室序贯起搏。在基线、心房起搏期间、冲洗后和房室序贯起搏期间测量CS乳酸水平。结果：基线CS乳酸为0.55±0.15 mmol/L，心房起搏时CS乳酸升高至1.13±0.29 mmol/L。洗脱后，水平恢复到接近基线（0.59±0.21 mmol/L）。最佳AVD（142.8±20.6 ms）时房室序贯起搏时，CS乳酸降低至0.86±0.31 mmol/L，与心房起搏相比有显著降低（p = 0.026）。在18例患者中，有15例在房室起搏时乳酸CS下降。结论：优化AVD时房室序贯起搏可降低大多数nHCM患者运动时乳酸CS，改善心肌氧平衡，减少微血管缺血。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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