Does Disopyramide Still Have a Place in the Management of Obstructive Hypertrophic Cardiomyopathy?

Hypertrophic cardiomyopathy is a relatively common inherited cardiac disorder associated with a left ventricular (LV) hypertrophy that cannot be explained by another cardiac or systemic disorder. One of the core pathophysiology features is LV outflow tract obstruction (obstructive HCM or oHCM), and this pathology could lead to complications, including sudden cardiac death and heart failure. Current treatment strategies for symptomatic oHCM consist of historical pharmacologic agents that are often based on nonrandomized, limited data or expert opinion. This article presents a critical appraisal of disopyramide, one of the pharmacological options available in Canada for managing oHCM. The author concludes that there is a lack of robust clinical evidence supporting the use of disopyramide in treating oHCM, and that disopyramide should be reserved as a last resort for non-responders to pharmacological treatment and for those in whom invasive therapies are not indicated.