Key result
Preserving a fully efficient left atrial contribution to left ventricular filling is critical in patients with hypertrophic obstructive cardiomyopathy treated with permanent cardiac pacing.
Highlights the pathophysiological importance of atrial contraction in hypertrophic cardiomyopathy and the need to preserve it during permanent pacing.
AV optimization warrants consideration in paced HOCM to preserve atrial filling; leaves open ideal strategies for prospective trials.
Hypertrophic cardiomyopathy is a primary myocardial disease characterized anatomically by left ventricular (LV) asymmetric hypertrophy and pathophysiologically by normal or even supernormal systolic ejection performance contrasting with impaired diastolic function. Altered ventricular relaxation tends to reduce the contribution of rapid ventricular filling to total LV filling volumes. Consequently, the contribution of left atrial (LA) contraction can be significantly increased. In some patients LV filling, and thus stroke volume, critically depend upon atrial systole. These data may have important clinical implications especially in patients treated with permanent cardiac pacing. Preserving a fully efficient LA contribution to LV filling is probably a key point in those patients .
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Daubert et al. (1996) conducted a review in Hypertrophic Obstructive Cardiomyopathy. Permanent cardiac pacing was evaluated. Preserving a fully efficient left atrial contribution to left ventricular filling is critical in patients with hypertrophic obstructive cardiomyopathy treated with permanent cardiac pacing.
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