Why the study?
Does left ventricular apex epicardial pacing reduce LV outflow tract pressure gradient and improve symptoms in a patient with severe HOCM refractory to medical therapy?
Does left ventricular apex epicardial pacing reduce LV outflow tract pressure gradient and improve symptoms in a patient with severe HOCM refractory to medical therapy?
Left ventricular apex epicardial pacing may serve as an effective alternative therapy for reducing LV outflow tract gradients in patients with severe HOCM refractory to medical treatment and standard pacing.
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May offer alternative pacing in refractory HOCM; hypothesis-generating and requires prospective validation before practice change.
We report a case of severe hypertrophic obstructive cardiomyopahy (HOCM) that was markedly improved by left ventricular (LV) apex epicardial pacing. A 55-year-old woman with HOCM had suffered from dyspnea. Cardiac catheter examination showed a resting pressure gradient across the LV outflow tract of 198 mmHg despite combined medication. During the examination, right dual-chamber pacing could not sufficiently reduce the pressure gradient. Therefore, we treated the patient with LV apex epicardial pacing. The procedure decreased the pressure gradient to 10 mmHg. Clinical symptoms were markedly improved. LV apex epicardial pacing may be an alternative therapy for patients with HOCM who are refractory to other medical treatment.
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Yufu et al. (2004) studied this question.
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