Key result
Permanent right ventricular apex pacing achieved symptomatic improvement and reduction of left ventricular pressure gradient in 100% (3/3) of patients with relapse after alcohol septal ablation.
Why the study?
Does permanent right ventricular apex pacing improve symptoms and reduce left ventricular pressure gradient in HOCM patients with recurrence after alcohol septal ablation?
Case Report (n=3)
Does permanent right ventricular apex pacing improve symptoms and reduce left ventricular pressure gradient in HOCM patients with recurrence after alcohol septal ablation?
Permanent right ventricular apex pacing may serve as an effective niche treatment for HOCM patients experiencing recurrence of midventricular obstruction and symptoms after alcohol septal ablation.
May support pacing as salvage option in post-ablation HOCM relapse; hypothesis-generating and requires prospective trials.
Treatment of symptom recurrence after initially successful alcohol septal ablation (ASA) in hypertrophic obstructive cardiomyopathy (HOCM) when accompanied by relapse of intracavitary left ventricular pressure gradient (LVG) is guided by the underlying mechanism. We describe our experience with permanent pacing in three patients with relapse of both LVG and symptoms 7 to 12 months after successful ASA. Even though pressure gradient recurrence was observed at midventricular level, we were able to achieve symptomatic improvement and LVG reduction after right ventricular apex pacing in all three cases. The effect on symptoms was long lasting-the 6-month followup echo-stress tests confirmed good exercise capacity and lack of provocable LVG. We found pacing to be a safe and effective treatment option in this clinical scenario. Based on our overall observations, we propose pacing as a niche treatment for patients with recurrence of LVG at midventricular level after ASA.
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Velchev et al. (2012) conducted a case report in Hypertrophic obstructive cardiomyopathy (HOCM) (n=3). Permanent pacing (right ventricular apex pacing) was evaluated on Symptomatic improvement and left ventricular pressure gradient (LVG) reduction. Permanent right ventricular apex pacing achieved symptomatic improvement and reduction of left ventricular pressure gradient in 100% (3/3) of patients with relapse after alcohol septal ablation.
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