Hypertensive left ventricular hypertrophy with left ventricular outflow tract obstructive physiology: a case of successful treatment with dual-chamber pacing.
Controversy exists over the use of atrioventricular synchronous pacing for patients with hypertrophic obstructive cardiomyopathy who are refractory to medical treatment. We present the case of an elderly man with severe-effort dyspnea attributable to hypertensive left ventricular hypertrophy with dynamic aortic outflow obstruction. We were able to achieve dramatic subjective and objective improvement in the exercise capacity of this patient with dual-chamber pacing after attempts at medical management had failed. This patient's response to therapy and his impressive response to minor pacemaker adjustments suggest that atrioventricular synchronous pacing should be considered for patients with secondary left ventricular hypertrophy as well as patients with hypertrophic obstructive cardiomyopathy.
Wicks
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AB
Cardiology Service, Madigan Army Medical Center, Tacoma, WA, USA.
Stajduhar
K
K
Mascette
A
A
D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000209:etiology* / Q000628:therapy*; D004417:Dyspnea / Q000209:etiology; D005080:Exercise Test; D006801:Humans; D006973:Hypertension / Q000150:complications*; D017379:Hypertrophy, Left Ventricular / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D014694:Ventricular Outflow Obstruction / Q000209:etiology* / Q000628:therapy*