Clinical benefit of dual chamber pacing in hypertrophic cardiomyopathy: A case report

This case study presents evidence that angioplasty and dual chamber pacing can be used as a therapeutic alternative to coronary artery bypass grafting and myectomy. The following case report describes this treatment option in a patient with hypertrophic cardiomyopathy and ischemic heart disease who refused surgery. A severe coronary lesion was successfully treated with percutaneous transluminal coronary angioplasty (PTCA). Subsequent deterioration of the patient's clinical status occurred, yet a repeat heart catheterization revealed no angiographic changes from the PTCA. The left ventricular outflow gradient was 97 mmHg despite optimizing medical therapy. Temporary pacing leads were inserted and the patient was DDD paced at 70 ppm while measuring the LV gradient at varying AV intervals. Significant reduction of the outflow tract gradient occurred at all AV intervals tested. Although the pressure gradient decreased during VVI pacing, atrial contribution was necessary to achieve the desired hemodynamic benefit. A permanent DDDR pacemaker was implanted with satisfactory clinical results.