Abstract
Oral verapamil, 5.2 ± 1.1 mg/kg/day (range 2.8 to 7), was administered to 13 pediatric patients with hypertrophic Cardiomyopathy for 13 ± 6 months (range 2 to 20). The patients had significant symptomatic improvement on verapamil therapy. Murmur intensity diminished in 6 patients during therapy and left ventricular (LV) electromotive forces on the electrocardiogram diminished in 4, increased in 5 and did not change in 4. Exercise endurance increased from 8.4 ± 3.9 to 10.9 ± 2.8 minutes (p < 0.01). Seven patients had ST-segment depression (0.38 ± 0.28 mV) before verapamil therapy, which improved after verapamil therapy in 5 (0.24 ± 0.17 mV, p < 0.02). Of 4 patients with exercise-induced ventricular ectopic activity, 3 had diminution or abolishment of ectopy following verapamil. By echocardiography, the patients had an increase in LV end-diastolic dimension from 3.4 ± 0.7 to 3.9 ± 0.8 cm (p < 0.01), with no significant change in shortening fraction (46.1 ± 8.0% vs 44.6 ± 8.0%). When adjusted for body size and age there was a significant decrease in LV septal thickness (from 106 ± 70 to 45 ± 52% of predicted normal values, p < 0.05) and LV posterior wall thickness (from 40 ± 45 to 5 ± 26% of predicted normal values p = 0.05) after verapamil. Isovolumic relaxation time decreased from 69 ± 26 to 42 ± 19 ms after verapamil (p < 0.01). Systolic anterior motion of the anterior mitral leaflet disappeared in 5 of 8 patients and midsystolic closure of the aortic valve was no longer present in 4 of 8. Chronic oral verapamil appears to be an effective form of therapy for pediatric patients with hypertrophic Cardiomyopathy.
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