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(Circulation. 1999;100:786-788.)
© 1999 American Heart Association, Inc.

Editorials

Cardiac Pacing

An Alternative Treatment for Selected Patients With Hypertrophic Cardiomyopathy and Adjunctive Therapy for Certain Patients With Dilated Cardiomyopathy

Robert A. O'Rourke, MD

From the Department of Medicine/Cardiology, The University of Texas Health Science Center at San Antonio.

Correspondence to Robert A. O'Rourke, MD, Department of Medicine/Cardiology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78284-7872.

Key Words: Editorials • pacing • cardiomyopathy

	Introduction

 
The use of pacemaker technology for treating cardiomyopathies has provoked keen interest and enthusiastic support in the past decade.^{1 2 3 4 5 6 7 8 9} Often, the hemodynamic abnormalities associated with heart disease can be modified, at least for the short term, by altering the timing, sequence, and site of cardiac electrical activation. In both hypertrophic cardiomyopathy and dilated cardiomyopathy, dual-chamber pacing has relieved symptoms and improved hemodynamics in certain patients. However, pacing techniques should be used as a therapeutic approach to individual patients rather than as routine therapy for most patients with cardiomyopathies. Only recently have controlled, randomized studies assessed the usefulness of dual-chamber (VDD and DDD) pacing in patients with hypertrophic or dilated cardiomyopathies.^{10 11}

	Pacing for Hypertensive Hypertrophy With Cavity Obliteration

 
As reported in this issue of Circulation, Kass and associates¹² implanted dual-chamber pacemakers (VDD) in 9 patients with exertional dyspnea attributed to hypertensive left ventricular (LV) hypertrophy with supranormal systolic ejection (mean ejection fraction 85%) and distal cavity obliteration (hypertensive hypertrophy with cavity obliteration; HHCO). In this small number of patients, intrinsic atrial rate was sensed and ventricular preactivation achieved by shortening the atrial-ventricular (AV) delay.

All patients had concentric hypertrophy with markedly increased septal and LV free-wall thickness, no systolic anterior motion of the mitral valve, and an intracavitary pressure gradient between distal and basal LV regions.

VDD pacing was randomized to "on" or "off" for 3-month periods followed by 6 additional pacing "on" months. With pacing on, exercise duration rose by an average of 82% and maximum oxygen consumption increased 24% above that measured when pacing was . . . [Full Text of this Article]

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