Antiarrhythmic drug cibenzoline attenuates left ventricular pressure gradient and improves transmitral doppler flow pattern in patients with hypertrophic obstructive cardiomyopathy caused by midventricular obstruction

Abstract

Background: Recent interventional and surgical therapies to attenuate left ventricular pressure gradient (LVPG) can be difficult to perform in patients with hypertrophic obstructive cardiomyopathy (HOCM) cuased by midventricular obstruction (MVO), owing to the risk of inducing or deteriorating mitral regurgitation. Methods and Results: The effects of the antiarrhythmic drug, cibenzoline, on LVPG and left ventricular (LV) diastolic function estimated by the change in the transmitral Doppler flow pattern were examined in 23 patients with HOCM and MVO. Hemodynamic changes 2h after a single dose of 200 mg of cibenzoline and 3 months after oral administration of 300-450 mg of cibenzoline per day were examined. At 2h after the treatment, LVPG decreased from 79±37 mmHg to 24±21 mmHg (p<0.0001). E-wave velocity significantly increased and A-wave velocity significantly decreased, and thus the E/A ratio increased from 0.83±0.39 to 1.36±0.50 (p<0.0001). After 3 months of treatment, LVPG remained decreased, and the E-wave and A-wave velocities and the E/A ratio remained improved. Conclusions: Cibenzoline can attenuate LVPG and ameliorate LV diastolic dysfunction in patients with HOCM caused by MVO, which suggests a new strategy for the management of this condition.