Modification of atrioventricular conduction as adjunct therapy for pacemaker-treated patients with hypertrophic obstructive cardiomyopathy.

AIMS Atrioventricular synchronous pacing offers symptomatic relief for patients with drug-refractory hypertrophic obstructive cardiomyopathy. Successful treatment requires complete right ventricular apical pre-excitation. Enhanced atrioventricular conduction renders this difficult in some patients. The aim of this study was to evaluate whether selective prolongation of atrioventricular conduction is a useful tool for optimization of treatment in patients with hypertrophic obstructive cardiomyopathy primarily refractory to cardiac pacing. METHODS Six patients refractory to pacemaker treatment for 3-19 months underwent radiofrequency modification of atrioventricular conduction. Patients were followed with echo-Doppler, exercise testing and clinical evaluation for 6-12 months after modification. RESULTS Intrinsic PQ time was significantly prolonged from 175 +/- 18 ms to 253 +/- 22 ms; however, one patient exhibited complete block at one month follow-up. Left ventricular outflow tract obstruction decreased from 74 +/- 17 mmHg to 28 +/- 27 mmHg at the 6-month follow-up. Symptomatic improvement of at least one functional class was recorded in all patients; exercise tolerance remained unchanged, however, less angina and dyspnoea were reported in everyday life. CONCLUSION Radiofrequency modification of atrioventricular conduction, with persistent prolongation of the PQ interval, enhances the effects of pacing in patients with hypertrophic obstructive cardiomyopathy. This treatment enhances left ventricular outflow tract gradient reduction and improves symptoms.