{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T04:41:22Z","timestamp":1775018482003,"version":"3.50.1"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Patients with refractory, symptomatic left ventricular (LV) mid-cavity obstructive (LVMCO) hypertrophic cardiomyopathy have few therapeutic options. Right ventricular pacing is associated with modest hemodynamic and symptomatic improvement, and LV pacing pilot data suggest therapeutic potential. We hypothesized that site-specific pacing would reduce LVMCO gradients and improve symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Patients with symptomatic-drug-refractory LVMCO were recruited for a randomized, blinded trial of personalized prescription of pacing (PPoP). Multiple LV and apical right ventricular pacing sites were assessed during an invasive hemodynamic study of multisite pacing. Patient-specific pacing-site and atrioventricular delays, defining PPoP, were selected on the basis of LVMCO gradient reduction and acceptable pacing parameters. Patients were randomized to 6 months of active PPoP or backup pacing in a crossover design. The primary outcome examined invasive gradient change with best-site pacing. Secondary outcomes assessed quality of life and exercise following randomization to PPoP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      A total of 17 patients were recruited; 16 of whom met primary end points. Baseline New York Heart Association was 3\u00b10.6, despite optimal medical therapy. Hemodynamic effects were assessed during pacing at the right ventricular apex and at a mean of 8 LV sites. The gradients in all 16 patients fell with pacing, with maximum gradient reduction achieved via LV pacing in 14 (88%) patients and right ventricular apex in 2. The mean baseline gradient of 80\u00b129 mm\u2005Hg fell to 31\u00b121 mm\u2005Hg with best-site pacing, a 60% reduction (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.0001). One cardiac vein perforation occurred in 1 case, and 15 subjects entered crossover; 2 withdrawals occurred during crossover. Of the 13 completing crossover, 9 (69%) chose active pacing in PPoP configuration as preferred setting. PPoP was associated with improved 6-minute walking test performance (328.5\u00b199.9 versus 285.8\u00b1105.5 m;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.018); other outcome measures also indicated benefit with PPoP.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In a randomized placebo-controlled trial, PPoP reduces obstruction and improves exercise performance in severely symptomatic patients with LVMCO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\">https:\/\/clinicaltrials.gov\/study<\/jats:ext-link>\n                      ; Unique Identifier: NCT03450252.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circep.123.012570","type":"journal-article","created":{"date-parts":[[2024,6,19]],"date-time":"2024-06-19T05:00:42Z","timestamp":1718773242000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Distal Ventricular Pacing for Drug-Refractory Mid-Cavity Obstructive Hypertrophic Cardiomyopathy: A Randomized, Placebo-Controlled Trial of Personalized Pacing"],"prefix":"10.1161","volume":"17","clinical-trial-number":[{"clinical-trial-number":"nct03450252","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9860-3800","authenticated-orcid":true,"given":"James W.","family":"Malcolmson","sequence":"first","affiliation":[{"name":"Barts Heart Center, St Bartholomew\u2019s Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)."},{"name":"William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (J.W.M., K.K., A.E.L., S.E.P., S.A.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2110-5234","authenticated-orcid":true,"given":"Rebecca K.","family":"Hughes","sequence":"additional","affiliation":[{"name":"Barts Heart Center, St Bartholomew\u2019s Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)."},{"name":"Institute of Cardiovascular Science, University College London, United Kingdom (R.K.H., E.C.W., J.C.M., L.R.L., C.O.M., P.M.E.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7058-3319","authenticated-orcid":true,"given":"Tim","family":"Husselbury","sequence":"additional","affiliation":[{"name":"Barts Heart Center, St Bartholomew\u2019s Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamran","family":"Khan","sequence":"additional","affiliation":[{"name":"William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (J.W.M., K.K., A.E.L., S.E.P., S.A.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6964-9041","authenticated-orcid":true,"given":"Annastazia E.","family":"Learoyd","sequence":"additional","affiliation":[{"name":"William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (J.W.M., K.K., A.E.L., S.E.P., S.A.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Lees","sequence":"additional","affiliation":[{"name":"Barts Heart Center, St Bartholomew\u2019s Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleanor C.","family":"Wicks","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Science, University College London, United Kingdom (R.K.H., E.C.W., J.C.M., L.R.L., C.O.M., P.M.E.)."},{"name":"Inherited Cardiovascular Diseases Unit, John Radcliffe Hospital, London, United Kingdom (E.C.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie","family":"Smith","sequence":"additional","affiliation":[{"name":"Raigmore Hospital, NHS Highland, Inverness, United Kingdom (J.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander D.","family":"Simms","sequence":"additional","affiliation":[{"name":"Yorkshire Heart Centre, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom (A.D.S.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8071-1491","authenticated-orcid":true,"given":"James C.","family":"Moon","sequence":"additional","affiliation":[{"name":"Barts Heart Center, St Bartholomew\u2019s Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)."},{"name":"Institute of Cardiovascular Science, University College London, United Kingdom (R.K.H., E.C.W., J.C.M., L.R.L., C.O.M., P.M.E.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6408-4667","authenticated-orcid":true,"given":"Luis R.","family":"Lopes","sequence":"additional","affiliation":[{"name":"Barts Heart Center, St Bartholomew\u2019s Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)."},{"name":"Institute of Cardiovascular Science, University College London, United Kingdom (R.K.H., E.C.W., J.C.M., L.R.L., C.O.M., P.M.E.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6931-4647","authenticated-orcid":true,"given":"Constantinos","family":"O\u2019Mahony","sequence":"additional","affiliation":[{"name":"Barts Heart Center, St Bartholomew\u2019s Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)."},{"name":"Institute of Cardiovascular Science, University College London, United Kingdom (R.K.H., E.C.W., J.C.M., L.R.L., C.O.M., P.M.E.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neha","family":"Sekhri","sequence":"additional","affiliation":[{"name":"Barts Heart Center, St Bartholomew\u2019s Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3383-3984","authenticated-orcid":true,"given":"Perry M.","family":"Elliott","sequence":"additional","affiliation":[{"name":"Barts Heart Center, St Bartholomew\u2019s Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)."},{"name":"Institute of Cardiovascular Science, University College London, United Kingdom (R.K.H., E.C.W., J.C.M., L.R.L., C.O.M., P.M.E.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4622-5160","authenticated-orcid":true,"given":"Steffen E.","family":"Petersen","sequence":"additional","affiliation":[{"name":"Barts Heart Center, St Bartholomew\u2019s Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., J.C.M., L.R.L., C.O.M., N.S., P.M.E., S.E.P., M.B.D., S.A.M.)."},{"name":"William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, United Kingdom (J.W.M., K.K., A.E.L., S.E.P., S.A.M.)."},{"name":"Health Data Research UK, London (S.E.P.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9148-9571","authenticated-orcid":true,"given":"Mehul B.","family":"Dhinoja","sequence":"additional","affiliation":[{"name":"Barts Heart Center, St Bartholomew\u2019s Hospital, Barts Health NHS Trust, London, United Kingdom (J.W.M., R.K.H., T.H., M.L., 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