AF, which occurs in approximately 25% of those with HCM and is more common in patients with LVOTO, (19) often presents clinically as acute heart failure because of the reduced diastolic filling.
Additional therapeutic options for patients without LVOTO include calcium channel blockers, nitrates, and diuretics.
Patients with LVOTO or abnormal mitral motion are at moderate risk of spontaneous bacterial endocarditis (SBE).
Invasive treatments may be considered for patients with LVOTO who do not respond to medical management.
Septal myomectomy is the gold standard for refractory LVOTO.
Dual-chamber (DDD) pacing can also be used to treat LVOTO, but studies comparing pacing with myomectomy and ablation have found mixed results.
35) This recommendation is not dependent on the presence of LVOTO or on patient symptoms, medical or surgical therapy, or the placement of an AICD.