Fig. (11).

Proposed treatment path for patients with obstructive hypertrophic cardiomyopathy. Note that patients generally should receive aggressive pharmacologic therapy before referral to invasive therapy. Patients resistant to beta-blockade or verapamil form a discrete patient group who are candidates for advanced care: treatments available include disopyramide, surgical septal myectomy, alcohol septal ablation and DDD pacing with short AV delay. Reproduced by permission Fifer MA, Vlahakes GJ. Management of symptoms in hypertrophic cardiomyopathy. Circulation 2008; 117: 429-39.