Therapeutic options for patients with obstructive hypertrophic cardiomyopathy and drug-refractory symptoms include cardiac surgery, percutaneous septal ablation and dual chamber cardiac pacing. Early reports of beneficial haemodynamic and symptomatic effects of ventricular pacing were not supported by results of short-term pacing in randomised studies. More recently, several studies have reported significant and sustained improvements in patient symptoms following long-term pacing. Additionally, the increasing use of pacemaker-defibrillator devices for the primary prevention of sudden death in hypertrophic cardiomyopathy provides an opportunity to attempt a therapeutic trial of pacing in appropriate cases. In this context, we review the role of pacing in hypertrophic cardiomyopathy.
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