Abstract
[first paragraph of article]About one-third of patients with hypertrophic cardiomyopathy (HCM) have resting left ventricular outflow tract obstruction (LVOTO). The presence of LVOTO in HCM facilitates the progression of heart failure and increases the risk of death. LVOTO is defined as a peak instantaneous Doppler LV outflow tract gradient ≥30 mmHg, but the threshold for invasive treatment is usually considered to be ≥50 mm Hg.
Highlights
About one-third of patients with hypertrophic cardiomyopathy (HCM) have resting left ventricular outflow tract obstruction (LVOTO)
In this review we describe the indications and the evidence of sequential DDD-AV pacing and the beneficial effects of biventricular pacing to reduce the gradient of LVOTO in patients with HCM
Sequential biventricular pacing in HOCM to reduce LVOTO Recent data show that atrial synchronous left ventricular (LV) or biventricular (BiV) pacing might further reduce the LVOT pressure gradient and improve symptoms in patients with
Summary
About one-third of patients with hypertrophic cardiomyopathy (HCM) have resting left ventricular outflow tract obstruction (LVOTO). Exercise tolerance was only improved in those with severe baseline impairment[5] Another randomized, double-blind cross-over study (the MPATHY study) with 48 patients confirmed significant benefit of pacing therapy on outflow gradient and quality of life score but without improved exercise capacity. Prolonged ventricular pacing appeared not to have negative effects on systolic or diastolic function[7] These studies do not provide sufficient data to compare results on all-cause mortality, cost effectiveness, exercise capacity, quality of life, and peak O2 consumption[8]. The conflicting data on both gradient reduction and functional capacity improvement mean that current clinical practice guidelines recommended sequential DDD pacing only for symptomatic patients who have contraindications for SAA or myectomy or are at high risk of developing heart block following SAA or myectomy. Sequential biventricular pacing in HOCM to reduce LVOTO Recent data show that atrial synchronous left ventricular (LV) or biventricular (BiV) pacing might further reduce the LVOT pressure gradient and improve symptoms in patients with
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