Treatment of Hypertrophic Obstructive Cardiomyopathy with Pacing

Abstract

Hemodynamic, metabolic or genetic disorders can lead to hypertrophy of the heart muscle. The hypertrophy is, whatever its cause, the source of symptoms such as dyspnea, syncope, angina or sudden death. Primary hypertrophic cardiomyopathy may present under 3 different forms: apical hypertrophy, diffuse hypertrophy, and asymmetric septal hypertrophy. This last form, when associated with obstruction, is referred as hypertrophic obstructive cardiomyopathy, a disease with a significant morbidity and mortality. The most common causes of mortality, with a reported annual of rate 3 to 8%,¹ are sudden cardiac death due to arrhythmias or congestive heart failure. Medical therapy is considered as initial treatment and includes betablockers, calcium antagonists and disopyramid.^{2, 3} For drug refractory patients, surgical therapy consisting of septal myotomy, myotomy-myectomy and eventually mitral valve replacement or repair has been performed with good results.⁴ However, morbidity and mortality due to this intervention is not negligible.⁵