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Pacing for hypertrophic obstructive cardiomyopathy does it work?

Q Zaidi1, H Zaky, O Aljassim

  • 1Cardiology and Cardiothoracic Surgery Center, Dubai Hospital, P.O. Box 21910, Dubai, United Arab Emirates.

Journal of the Saudi Heart Association
|August 21, 2013
PubMed

Insights

A patient with hypertrophic obstructive cardiomyopathy (HOCM) experienced improved symptoms after receiving a dual chamber implantable cardioverter-defibrillator (ICD). Right ventricular apical pacing significantly reduced the left ventricular outflow tract (LVOT) pressure gradient.

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) is a significant cause of sudden cardiac arrest.
  • Management of HOCM often involves addressing the left ventricular outflow tract (LVOT) gradient.

Purpose of the Study:

  • To evaluate the efficacy of right ventricular apical pacing in managing symptomatic hypertrophic obstructive cardiomyopathy (HOCM) in a patient who declined septal myomectomy.

Main Methods:

  • A 69-year-old female patient with HOCM and sudden cardiac arrest received a dual-chamber implantable cardioverter-defibrillator (ICD).
  • The patient was programmed for right ventricular apical pacing with a short atrioventricular (AV) interval.

Main Results:

  • Post-pacing, the maximum pressure gradient across the left ventricular outflow tract (LVOT) decreased from 117 mmHg to 21 mmHg.
  • The patient reported significant improvement in symptoms during a one-year follow-up period.

Conclusions:

  • Right ventricular apical pacing with a short AV interval can be an effective strategy for reducing the LVOT gradient and improving symptoms in select HOCM patients.
  • This pacing strategy offers an alternative management option for HOCM patients who are not candidates for or decline surgical intervention.

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