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Pacing for hypertrophic obstructive cardiomyopathy: an update and future directions
Claude Daubert1,2, Fredrik Gadler3,4, Philippe Mabo1,2,5
1Faculté de Médecine, Université de Rennes 1, France.
Summary
AV sequential pacing offers a simple yet effective treatment for hypertrophic cardiomyopathy (HCM) patients with left ventricular outflow tract obstruction (LVOTO), improving symptoms and quality of life. Despite evidence, this therapy remains underutilized in clinical practice.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Practice
Background:
- Hypertrophic cardiomyopathy (HCM) with left ventricular outflow tract obstruction (LVOTO) presents limited treatment options.
- AV sequential pacing is a relatively simple yet underutilized therapeutic approach.
Purpose of the Study:
- To review the current evidence for AV sequential pacing in HCM patients with LVOTO.
- To contextualize pacing therapy within current clinical guidelines and highlight its underuse.
Main Methods:
- Review of observational, randomized, and long-term follow-up studies on AV sequential pacing.
- Discussion of mechanisms of action, prerequisites for successful pacing, and optimization strategies.
- Reference to ESC HCM guidelines regarding implantable cardioverter defibrillators (ICDs).
Main Results:
- AV sequential pacing demonstrates improvements in symptoms, quality of life, LVOTO, systolic anterior movement, and mitral regurgitation.
- Evidence regarding effects on morbidity and mortality is currently lacking.
- The therapy is underused despite supporting evidence from randomized controlled studies.
Conclusions:
- AV sequential pacing is an underutilized but effective treatment for symptomatic HCM with LVOTO.
- New randomized studies are investigating AV sequential pacing against other interventions, indicating renewed interest.
- Optimization of pacing therapy and the role of ICDs are crucial considerations.
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