Why is the patient still symptomatic after myectomy for HCM!

We describe the case of a young female patient with hypertrophic cardiomyopathy (HCM) with a dual chamber implantable cardioverter defibrillator (ICD), and complete heart block from a prior septal ablation procedure. Due to persistent left ventricular outflow tract (LVOT) obstruction and symptoms, she underwent surgical myectomy. Her exertional symptoms continued despite improved LVOT flow parameters. A comprehensive evaluation, including ICD interrogation, helped arrive at the correct diagnosis and treatment plan.