IHSS/HOCM and Dual Chamber Pacemakers

[Rich-Quigley]

  I was diagnosed with IHSS in 1991 and have been treated with drug therapy
  since that time.  As seems to be normal I continue to build tolerances to
  the drugs and require increasingly larger doses.  I currently take 480mg of
  Inderal, 240mg of Covera HS(verapamil) and 37mg of Dyazide. As you might
  quess, functioning normally at these drug levels is difficult. Recent echos
  show LV outflow pressures in the 87mm hg range and my doctor and I are now
  discussing a dual chamber pacemaker.  
  My research indicates that a myectomy and pacemaker are the two
  treatments of choice, after drug therapy, with alcohol ablation
  being experimental and showing mixed results.
  Since I don't have an arrythmia, how does the pacemaker help me?

[CCF CARDIO MD APS]

_
Dear Rich,
The pacemaker as a treatment for IHSS/HOCM is designed to time the contraction
of your heart muscle such that the bulging muscle in your septum doesn't contract
and obstruct outflow until some blood has already been ejected; the design is
structural as you see and NOT 100% successful.  Compare this to the excellent
results with a myomectomy done at an institution like the Cleveland Clinic where
the surgeons are very skilled at this procedure and have a lot of experience with the
work-up and actual surgical technique. I think your best bet is to get the opinion
of a cardiologist who will also consider myomectomy, not just a pacemaker.  Alcohol ablation
currently is reserved for those who can not undergo myomectomy (a proven, definitive, effective
procedure.)
hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician
can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire
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cardiology staff that can be used to select the physician best suited to address your cardiac problem.