Hypertrophic Obstructive Cardiomyopathy: Is DDD Pacing Really Useful?

  • J. C. Daubert
  • D. Pavin
  • H. Le Breton
  • D. Gras


For more than 30 years [1], it has been known that apical stimulation of the right ventricle with total ventricular capture can reduce or even abolish systolic obstruction in hypertrophic obstructive cardiomyopathy (HOCM) (Fig. 1). This effect probably results from the reversal of the ventricular activation sequence, which delays septal thickening and SAM occurrence, and reduces left ventricular hyperkinesia. However, ventricular capture can only be hemodynamically beneficial (increase in stroke volume and systolic arterial pressure) provided optimal ventricular filling is maintained through fully effective left atrial function. This dual prerequisite (full ventricular capture and optimal atrioventricular synchrony) explains why it took up until recent years [2] and the introduction of highly sophisticated dual-chamber pacemakers for it to claim any clinical benefit. However the clinical relevance of this new therapeutic approach still remains controversial.


Hypertrophic Obstructive Cardiomyopathy LVOT Gradient Ventricular Capture Interatrial Conduction Time Spontaneous Sinus Rhythm 
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Copyright information

© Springer-Verlag Italia 1998

Authors and Affiliations

  • J. C. Daubert
    • 1
  • D. Pavin
    • 1
  • H. Le Breton
    • 1
  • D. Gras
    • 1
  1. 1.Service de Cardiologie AHôtel Dieu/CHRURennesFrance

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