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Multicenter study of the efficacy and safety of disopyramide in obstructive hypertrophic cardiomyopathy
Open accessAbstract
Objectives In this study we assessed the long-term efficacy and safety of disopyramide for patients with obstructive hypertrophic cardiomyopathy (HCM).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.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.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).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.
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“Disopyramide has been shown in retrospective studies to be safe and associated with an improvement in both LVOT gradient and symptoms when used in combination with β blockers or non-dihydropyridine CCBs.”
From Current management of hypertrophic cardiomyopathy (2025) · cites this paper as [30]
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“has been shown to reduce LV outflow gradient and improve symptoms in patients with hypertrophic cardiomyopathy.[662][663][664]”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [662]
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“Disopyramide, historically considered the most potent negative inotrope for oHCM, has demonstrated efficacy in reducing LVOT gradients and deferring SRT in long-term observational studies [80].”
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Concomitant Aficamten and Disopyramide in Symptomatic Obstructive Hypertrophic Cardiomyopathy
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“To manage the pressure gradient, beta-blockade with Class 1A anti-arrhythmic drugs have been recommended.(3,4) In this case, intravenous propranolol .”
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HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
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Stereoselective block of the hERG potassium channel by the Class Ia antiarrhythmic drug disopyramide
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“Disopyramide is an effective antiarrhythmic drug used in the management of HCM, particularly for reducing LVOTO [72].”
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Diagnosis and Treatment of Hypertrophic Cardiomyopathy
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“The class Ia antiarrhythmic agent, disopyramide has been demonstrated to reduce the LVOT pressure gradient and improve the clinical prognosis of the patients with hypertrophic obstructive cardiomyopathy [4].”
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“Disopyramide is also useful for reducing LV outflow gradients in patients with hypertrophic cardiomyopathy, especially when BB treatment is contraindicated.(43) It is noted to have more adverse effects, including heart failure, although efficacy for maintaining sinus rhythm 6 months after cardioversion was comparable…”
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“8 A fair number of patients will continue to have disabling symptoms despite optimized medical therapy, however.”
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Anti-arrhythmic Drugs—a Review and Comment on Relevance in the Current Era: Part 1
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“More importantly, disopyramide had found a niche use in patients with hypertrophic obstructive cardiomyopathy (HOCM) due to its negative inotropic effects on the LV myocardium which can result in up to 50% drop in the dynamic ventriculo-aortic outflow gradient in two-thirds of patients [27].”
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Hypertrophic Cardiomyopathy in Childhood
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Metadata
- Authors
- Sherrid, M. V., Barac, I., McKenna, W. J., Elliott, P. M., Dickie, S., Chojnowska, L., Casey, S., & Maron, B. J.
- Affiliations
- St. Luke's-Roosevelt Hospital Center (US)
- St George's, University of London (GB)
- Institute of Cardiology (PL)
- Minneapolis Heart Institute Foundation (US)
- Corresponding author
- Sherrid, Mark V.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2005-04
- Volume
- 45
- Issue
- 8
- Pages
- 1251-1258
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1992100033
- Cited by
- 410
- References
- 52
- Citations by year
- 2026: 12 · 2025: 35 · 2024: 34 · 2023: 24 · 2022: 23 · 2021: 23 · 2020: 20 · 2019: 14 · 2018: 19 · 2017: 16 · 2016: 15 · 2015: 17 · 2014: 27 · 2013: 18 · 2012: 22
- FWCI
- 8.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Immunology Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- disopyramide, hypertrophic obstructive cardiomyopathy, left ventricular outflow tract gradient, long-term efficacy, drug safety, sudden cardiac death, cardiac mortality, drug-induced arrhythmia, beta-blockers, myectomy, alcohol septal ablation, NYHA functional class
- MeSH terms
- Administration, Oral, Adrenergic beta-Antagonists, Anti-Arrhythmia Agents, Cardiomyopathy, Hypertrophic, Disopyramide, Echocardiography, Female, Humans, Male, Middle Aged, Myocardial Contraction, Safety, Death, Sudden, Cardiac, Treatment Outcome
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