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HOCM 3 Lead Pacing?

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
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74076 tn?1189759432
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.
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