{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:39:53Z","timestamp":1790419193084,"version":"4.1.0"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[1999,6,8]]},"abstract":"<jats:p>\n                    <jats:italic>Background<\/jats:italic>\n                    \u2014Dual-chamber pacing (DDD) has been proposed as a treatment alternative to surgery for severely symptomatic patients with obstructive hypertrophic cardiomyopathy (HCM), based largely on uncontrolled studies.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Methods and Results<\/jats:italic>\n                    \u2014This prospective, multicenter trial assessed pacing in 48 symptomatic HCM patients with \u226550 mm Hg basal gradient, refractory to drug therapy. Patients were randomized to 3 months each of DDD pacing and pacing backup (AAI-30) in a double-blind, crossover study design, followed by an uncontrolled and unblinded 6-month pacing trial. With randomization, no significant differences were evident between pacing and no pacing for subjective or objective measures of symptoms or exercise capacity, including NYHA functional class, quality of life score, treadmill exercise time or peak oxygen consumption. After 6 additional months of unblinded pacing, functional class and quality of life score were improved compared with baseline (\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.01), but peak oxygen consumption was unchanged. Outflow gradient decreased 40%, 82\u00b132 mm Hg to 48\u00b132 mm Hg (\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.001), and was reduced in 57% of patients but showed no change or an increase in 43%. At 12 months, 6 individual patients (12%) showed improved functional capacity; each was 65 to 75 years of age. Left ventricular wall thicknesses in the overall study group showed no remodeling between baseline (22\u00b15 mm) and 12 months (21\u00b15 mm;\n                    <jats:italic>P=<\/jats:italic>\n                    NS).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions<\/jats:italic>\n                    \u2014(1) Pacing cannot be regarded as a primary treatment for obstructive HCM; (2) with randomization, perceived symptomatic improvement was most consistent with a substantial placebo effect; (3) longer, uncontrolled pacing periods were associated with some subjective benefit but unaccompanied by objective improvement in cardiovascular performance and should be interpreted cautiously; (4) modest reduction in outflow gradient was achieved in most patients; and (5) a small subset (12%) \u2265 65 years of age showed a clinical response, suggesting that DDD pacing could be a therapeutic option for some elderly patients.\n                  <\/jats:p>","DOI":"10.1161\/01.cir.99.22.2927","type":"journal-article","created":{"date-parts":[[2012,6,11]],"date-time":"2012-06-11T20:42:29Z","timestamp":1339447349000},"page":"2927-2933","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":392,"title":["Assessment of Permanent Dual-Chamber Pacing as a Treatment for Drug-Refractory Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy"],"prefix":"10.1161","volume":"99","author":[{"given":"Barry J.","family":"Maron","sequence":"first","affiliation":[{"name":"From the Minneapolis Heart Institute Foundation (B.J.M.), Minneapolis, Minn; Mayo Clinic (R.A.N.), Rochester, Minn; St. George\u2019s Hospital Medical School (W.J.M.), London, England; Toronto Hospital (H.R.), Ontario, Canada; Beth Israel Hospital (M.E.J.), Boston, Mass; Medtronic, Inc. (R.S.K.), Minneapolis, Minn."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rick A.","family":"Nishimura","sequence":"additional","affiliation":[{"name":"From the Minneapolis Heart Institute Foundation (B.J.M.), Minneapolis, Minn; Mayo Clinic (R.A.N.), Rochester, Minn; St. George\u2019s Hospital Medical School (W.J.M.), London, England; Toronto Hospital (H.R.), Ontario, Canada; Beth Israel Hospital (M.E.J.), Boston, Mass; Medtronic, Inc. (R.S.K.), Minneapolis, Minn."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William J.","family":"McKenna","sequence":"additional","affiliation":[{"name":"From the Minneapolis Heart Institute Foundation (B.J.M.), Minneapolis, Minn; Mayo Clinic (R.A.N.), Rochester, Minn; St. George\u2019s Hospital Medical School (W.J.M.), London, England; Toronto Hospital (H.R.), Ontario, Canada; Beth Israel Hospital (M.E.J.), Boston, Mass; Medtronic, Inc. (R.S.K.), Minneapolis, Minn."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"Rakowski","sequence":"additional","affiliation":[{"name":"From the Minneapolis Heart Institute Foundation (B.J.M.), Minneapolis, Minn; Mayo Clinic (R.A.N.), Rochester, Minn; St. George\u2019s Hospital Medical School (W.J.M.), London, England; Toronto Hospital (H.R.), Ontario, Canada; Beth Israel Hospital (M.E.J.), Boston, Mass; Medtronic, Inc. (R.S.K.), Minneapolis, Minn."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E.","family":"Josephson","sequence":"additional","affiliation":[{"name":"From the Minneapolis Heart Institute Foundation (B.J.M.), Minneapolis, Minn; Mayo Clinic (R.A.N.), Rochester, Minn; St. George\u2019s Hospital Medical School (W.J.M.), London, England; Toronto Hospital (H.R.), Ontario, Canada; Beth Israel Hospital (M.E.J.), Boston, Mass; Medtronic, Inc. (R.S.K.), Minneapolis, Minn."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S.","family":"Kieval","sequence":"additional","affiliation":[{"name":"From the Minneapolis Heart Institute Foundation (B.J.M.), Minneapolis, Minn; Mayo Clinic (R.A.N.), Rochester, Minn; St. George\u2019s Hospital Medical School (W.J.M.), London, England; Toronto Hospital (H.R.), Ontario, Canada; Beth Israel Hospital (M.E.J.), Boston, Mass; Medtronic, Inc. 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