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Heart Disease (Expert Forum)
HOCM 3 Lead Pacing?
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HOCM 3 Lead Pacing?
by Annette1, Sep 23, 2004 12:00AM
First, I would like to thank you all for the invaluable service you provide! I am a 33 y/o, 245 lb, female with HOCM. I had a dual chamber AICD implanted in Sept. 2001 and was prescribed Toprol XL 50mg at that time. I noticed no improvement in my symptoms with these treatments. My follow-up care was very limited from 2001 until early 2004.
I am now seeing another cardiologist whom, thankfully, has put me through a myriad of test and procedures. We have finally concluded that I am obstructing mid-cavity. My resting gradient is very low; but my stress/exercise-induced gradient is around 80 (I pass out once it gets much higher). I have also begun experiencing atrial fibrillation in addition to the ventricular arrhythmias I was already aware of. My cardiologist has recommended several treatments including: medication, ablation, myectomy, weight loss, and adding a third lead to my AICD (actually replacing the existing unit with another). The latter option is the one my cardiologist and the electrophysiologist are recommending; but during our conversation, they said it “might” work and that there are really no studies on this therapy to say if would give me any relief. For now, I have chosen to take medication and try to loose weight (very hard, since I can not exercise). I have been taking Verapamil 120mg/24 hr tablets for a few weeks; but have not experienced any relief, yet. I am thinking of raising the dosage to 240mg.
Without knowing all the details, can you give me any advice as to what types of treatments are an option for me? I can only find one web site that mentions anything about three lead pacing.
I am now seeing another cardiologist whom, thankfully, has put me through a myriad of test and procedures. We have finally concluded that I am obstructing mid-cavity. My resting gradient is very low; but my stress/exercise-induced gradient is around 80 (I pass out once it gets much higher). I have also begun experiencing atrial fibrillation in addition to the ventricular arrhythmias I was already aware of. My cardiologist has recommended several treatments including: medication, ablation, myectomy, weight loss, and adding a third lead to my AICD (actually replacing the existing unit with another). The latter option is the one my cardiologist and the electrophysiologist are recommending; but during our conversation, they said it “might” work and that there are really no studies on this therapy to say if would give me any relief. For now, I have chosen to take medication and try to loose weight (very hard, since I can not exercise). I have been taking Verapamil 120mg/24 hr tablets for a few weeks; but have not experienced any relief, yet. I am thinking of raising the dosage to 240mg.
Without knowing all the details, can you give me any advice as to what types of treatments are an option for me? I can only find one web site that mentions anything about three lead pacing.
Doctor's Answer
by CCF-M.D.-MJM, Sep 23, 2004 12:00AM
Hi Annette,
I symptathise with your predicament. It is heard to lose weight if you cannon increase your activity.
It is true there are no studies to suggest that three lead pacing is better than 2 lead pacing for HOCM. The data for ventricular pacing and HOCM is not that strong.
I complete agree that losing weight is a must for your condition.
For patients with medically refractory symptoms related to HOCM, we typically move to a myectomy versus septal ablation to decrease your exertional outflow tract gradient. What makes your case a bit different is that you have mid cavitary gradient, a bit more difficult to reach via a standard surgical approach. If you are having significant symptoms and medications are not helping, I would move toward a mechanical solution (ie surgery vs septal alcohol ablation).
Sometimes you have to go to a major referral center for this to happen though. At the Clinic, Dr. Harry Lever specializes in HOCM. You may want to have a second opinion before proceeding with the pacemaker upgrade.
I hope this helps.
I symptathise with your predicament. It is heard to lose weight if you cannon increase your activity.
It is true there are no studies to suggest that three lead pacing is better than 2 lead pacing for HOCM. The data for ventricular pacing and HOCM is not that strong.
I complete agree that losing weight is a must for your condition.
For patients with medically refractory symptoms related to HOCM, we typically move to a myectomy versus septal ablation to decrease your exertional outflow tract gradient. What makes your case a bit different is that you have mid cavitary gradient, a bit more difficult to reach via a standard surgical approach. If you are having significant symptoms and medications are not helping, I would move toward a mechanical solution (ie surgery vs septal alcohol ablation).
Sometimes you have to go to a major referral center for this to happen though. At the Clinic, Dr. Harry Lever specializes in HOCM. You may want to have a second opinion before proceeding with the pacemaker upgrade.
I hope this helps.
