The importance of atrial contribution: A case study of dual-chamber pacing in hypertrophic obstructive cardiomyopathy

Beta blockers and calcium channel blockers are the mainstay of therapy for hypertrophic obstructive cardiomyopathy. Recent evidence suggests that dual-chamber pacing may also relieve symptoms in a subset of patients. Proper interval programming is critical to the success of this intervention—as well as maintenance of the atrial contribution to preserve left ventricular diastolic filling. This report illustrates the importance of atrial contribution, as well as the loss of atrial capture, which can lead to hemodynamic deterioration and recurrence of symptoms.