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      Dynamic Left Ventricular Outflow Tract Obstruction Post–Transcatheter Aortic Valve Replacement

      case-report

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          Abstract

          We describe the first case of successful management of left ventricular outflow tract obstruction developing late after transcatheter aortic valve replacement with right ventricular apical pacing. The possible mechanisms of obstruction resolution are described. ( Level of Difficulty: Advanced.)

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          Most cited references10

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          Pacing for hypertrophic obstructive cardiomyopathy: an update and future directions

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            Effect of biventricular pacing on left ventricular outflow tract pressure gradient in a patient with hypertrophic cardiomyopathy and normal interventricular conduction.

            We report a case of hypertrophic obstructive cardiomyopathy (HOCM) that was markedly improved by biventricular pacing. A 55-year-old woman with HOCM presented with palpitation and presyncope. Electrophysiologic study revealed an atrioventricular nodal reentrant tachycardia. After radiofrequency catheter ablation, a Mobitz type II atrioventricular block developed and a permanent pacemaker implantation was decided. Cardiac catheterization showed a left ventricular outflow tract (LVOT) gradient of 130 mmHg. Right dual-chamber and atrial-synchronous left ventricular epicardial pacing failed to reduce the gradient. After biventricular pacing, LVOT gradient decreased to 20 mmHg. Biventricular pacing may be an alternative therapy for patients with HOCM.
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              Long-term benefits of pacing in obstructive hypertrophic cardiomyopathy.

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                Author and article information

                Contributors
                Journal
                JACC Case Rep
                JACC Case Rep
                JACC Case Reports
                Elsevier
                2666-0849
                16 June 2021
                June 2021
                16 June 2021
                : 3
                : 6
                : 871-874
                Affiliations
                [1]Division of Cardiology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
                Author notes
                [] Address for correspondence: Dr. Hellmuth S. vH. Weich, Division of Cardiology, Tygerberg Hospital, Parow 7505, South Africa. hweich@ 123456sun.ac.za
                Article
                S2666-0849(21)00429-0
                10.1016/j.jaccas.2021.04.035
                8311343
                34317644
                4c1403bc-3d78-4545-92ec-88986ce329a5
                © 2021 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 8 September 2020
                : 1 April 2021
                : 27 April 2021
                Categories
                Mini-Focus Issue: Transcatheter Interventions
                Case Report: Clinical Case

                aortic valve,cardiomyopathy,pacemaker,valve replacement,hcm, hypertrophic cardiomyopathy,hocm, hypertrophic obstructive cardiomyopathy,lvh, left ventricular hypertrophy,lvot, left ventricular outflow tract,lvoto, left ventricular outflow tract obstruction,sam, systolic anterior motion of the mitral valve,savr, surgical aortic valve replacement,tavr, transcatheter aortic valve replacement

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