In some patients with hypertrophic cardiomyopathy, the dynamic left ventricular outflow
tract obstructive gradient results in exercise-limiting symptoms of dyspnea, angina,
and syncope. Dual chamber pacing has been proposed as a widely available alternative
treatment for a subset of patients with symptomatic hypertrophic obstructive cardiomyopathy.
Initial studies showed a reduction in gradient and an improvement in symptoms in almost
90% of patients with severe symptoms. We report the Mayo Clinic experience with dual
chamber pacing in 38 patients with hypertrophic obstructive cardiomyopathy who had
permanent pacemakers implanted for limiting symptoms intractable to medical therapy.
After a mean ± SD follow-up of 24±14 months, subjective improvement was reported in
47% of patients. However, there was no statistical difference between the maximal
oxygen consumption at last follow-up and AAI pacing (atrial sensing and atrial pacing)
(18.6±1.1 mL·kg−1.min−1) (ie, when the pacemaker was implanted but not pacing continuously). This article
discusses the clinical perspective on the utility of dual chamber pacing for patients
with hypertrophic obstructive cardiomyopathy.
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© 2000 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
