Dual chamber pacing has been proposed as an alternative to surgery in the management of hypertrophic cardiomyopathy. Reports have documented hemodynamic and symptomatic benefit from dual chamber pacing, raising the question of whether or not all patients with drug-refractory symptoms should undergo a trial of pacing before consideration of surgery. The enthusiasm for pacing in hypertrophic cardiomyopathy has generated a number of investigations addressing this issue, including several recently concluded clinical trials. This article reviews the recent experience with dual chamber pacing in hypertrophic cardiomyopathy.