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Improvement of Microvascular Ischemia by Atrioventricular Sequential Pacing in Non-Obstructive Hypertrophic

Muthiah Subramanian1, Radhika Manukonda1, Sachin Yalagudri1

  • 1Department of Electrophysiology, Department of Cardiology AIG Institute of Cardiac Sciences and Research Hyderabad India.

Journal of Arrhythmia
|August 5, 2026
PubMed

Insights

Right ventricular apical pacing with optimized atrioventricular delay improves myocardial oxygen balance in patients with non-obstructive hypertrophic cardiomyopathy. This pacing strategy reduces coronary sinus lactate, indicating decreased microvascular ischemia during exertion.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiovascular Physiology

Background:

  • Symptomatic non-obstructive hypertrophic cardiomyopathy (nHCM) has limited therapeutic options.
  • Investigating novel pacing strategies to improve cardiac function in nHCM is crucial.

Purpose of the Study:

  • To evaluate if right ventricular apical (RVA) pacing with optimal atrioventricular delay (AVD) can improve myocardial oxygen supply-demand mismatch in nHCM.
  • To assess microvascular ischemia using coronary sinus (CS) lactate levels.

Main Methods:

  • Patients with nHCM underwent atrial pacing and subsequently AV sequential pacing with individually optimized AVD.
  • Coronary sinus (CS) lactate levels were measured at baseline, during atrial pacing, and during AV sequential pacing.

Main Results:

  • Baseline CS lactate increased significantly during atrial pacing.
  • AV sequential pacing at optimal AVD resulted in a significant reduction in CS lactate compared to atrial pacing (p=0.026).
  • In 15 out of 18 patients, CS lactate levels decreased during AV pacing, indicating improved myocardial oxygen balance.

Conclusions:

  • Optimized AV sequential pacing in nHCM patients effectively reduces markers of microvascular ischemia.
  • This pacing strategy shows potential for improving myocardial oxygen balance in symptomatic nHCM.
Abstract

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