Role of Percutaneous Septal Ablation in Hypertrophic Obstructive Cardiomyopathy

Kimmelstiel, Carey; Maron, Barry J.

doi:10.1161/01.cir.0000114144.40315.c0

Cited by 69 publications

(39 citation statements)

References 13 publications

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“…22,32 The Kaplan-Meier method was used to estimate survival of the various end point events with 95% confidence intervals (CIs). Survival comparisons between groups were made with a 2-sample log-rank test.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it is still unknown as to whether this procedure enhances the propensity toward ventricular arrhythmias. 22,23 This issue may be particularly relevant in a younger population who may have a greater underlying propensity for ventricular arrhythmias and a longer latency period before a sudden catastrophic event.…”

Section: Sorajja Et Al Septal Ablation In Hcmmentioning

confidence: 99%

“…[12][13][14][15][16][17][18][19][20][21] Nonetheless, concerns about the efficacy of septal ablation compared with septal myectomy remain, in terms of acute complications, potential for arrhythmias, and overall outcome. 22,23 This study therefore was undertaken to examine the outcome of septal ablation compared with surgery in patients referred to a tertiary HCM referral center.…”

mentioning

confidence: 99%

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Outcome of Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy

Sorajja¹,

Valeti²,

Nishimura³

et al. 2008

Circulation

269

178

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Background-The clinical efficacy of alcohol septal ablation for drug-refractory hypertrophic cardiomyopathy remains unclear. This study examines the outcome of alcohol septal ablation performed at a tertiary hypertrophic cardiomyopathy referral center. Methods and Results-Among 601 patients with severely symptomatic obstructive hypertrophic cardiomyopathy referred for alcohol septal ablation or myectomy from 1998 to 2006, 138 patients (median age, 64 years; 39% men) chose to undergo ablation. Procedural complications included death in 1.4%, sustained ventricular arrhythmias in 3%, tamponade in 3%, and pacemaker implantation in 20%. This rate was higher than a combined complication rate of 5% in age-and gender-matched patients who had undergone septal myectomy at Mayo Clinic (PϽ0.0001). Four-year survival free of all mortality was 88.0% (95% confidence interval, 79.4 to 97.5%), which was similar to that of the age-and gender-matched patients who had undergone myectomy (Pϭ0.18). Six patients had documented ventricular arrhythmias after ablation, 4 of whom had successful intervention. Four-year survival free of death and severe New York Heart Association class III/IV symptoms after septal ablation was 76.4%, and 71 patients (51%) became asymptomatic. Myectomy patients Յ65 years of age had significantly better survival free of death and severe symptoms (Pϭ0.01). Conclusions-Alcohol septal ablation is an efficacious procedure if performed in an experienced institution and may resolve symptoms in a subset of patients with obstructive hypertrophic cardiomyopathy. However, the procedural complication rate exceeds that of myectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Sorajja Et Al Septal Ablation In Hcmmentioning

confidence: 99%

mentioning

confidence: 99%

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Outcome of Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy

Sorajja¹,

Valeti²,

Nishimura³

et al. 2008

Circulation

269

178

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“…Furthermore, given the uncertainty regarding potential long-term consequences of the PTSMA-induced intramyocardial septal scar, 1 we advocate creation of the smallest area of myocardial necrosis, which leads to the desired hemodynamic effect. Indeed, the application of myocardial contrast echocardiography as an adjunct to localizing the optimal septal vessel on which to intervene has led to reductions in infarct size and significant decrease in the requirement for permanent pacemaker implantation for PTSMA-induced complete heart block.…”

Section: Responsementioning

confidence: 99%

In Percutaneous Transluminal Septal Myocardial Ablation for Hypertrophic Obstructive Cardiomyopathy, It Is Not the Speed of Intracoronary Alcohol Injection But the Amount of Alcohol Injected That Determines the Resultant Infarct Size

Cheng

2004

Circulation

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“…Furthermore, comparative nonrandomized studies show that myomectomy and alcohol ablation are similarly associated with subjective improvement in NYHA functional class, but surgery yields more favorable outcomes with fewer early complications, more complete relief of obstruction, and greater exercise capacity and oxygen consumption [15]. Moreover, the risk for permanent complete heart block requiring pacing is up to 20 times greater with ablation (sometimes in young patients) than with myomectomy [15][16].…”

Section: Limitations Of Asamentioning

confidence: 99%

How Can we Improve Non-Surgical Septal Reduction for Hypertrophic Obstructive Cardiomyopathy?

Cleator¹,

Kasasbeh²

2016

J Cardiovasc Dis Diagn

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The goal for treatment of medical refractory Hypertrophic Obstructive Cardiomyopathy (HCM) is reduction of the hypertrophied left ventricular septum which obstructs blood flow. A surgical approach consists of an open-heart myomectomy, while the less invasive percutaneous approach involves creating a myocardial infarction by injecting 95 to 100% ethanol through a septal artery, a procedure termed alcohol septal ablation (ASA). Although less invasive than myomectomy, there are several limitations of alcohol septal ablation. The most important appears to be full thickness infarction that is often complicated by heart block and ventricular tachycardia/fibrillation. The ideal therapy for septal hypertrophy would be to find an agent that induces a less severe injury and/or atrophy of the hypertrophied septum. We review several alternative techniques for selective injury of the septum and describe the ideal characteristics of such an ideal agent. Our central hypothesis is that the anthracycline antibiotic such as doxorubicin may be the perfect agent. Anthracycline-based chemotherapies have been used in the treatment of solid and hematological tumors for many years. These agents have known cardiotoxic side effects that are related to cumulative dose which can lead to heart failure. Although the mechanism of action of doxorubicin cardiotoxicity is controversial, it is very clear that these agents cause atrophy of the myocardium, induce apoptosis and necrosis, as well as anti-angiogenic effects. We propose that selectively treating the hypertrophied septum of HCM patients with injection of the anthracycline doxorubicin will lead to superior outcomes compared to ASA.

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Role of Percutaneous Septal Ablation in Hypertrophic Obstructive Cardiomyopathy

Cited by 69 publications

References 13 publications

Outcome of Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy

Outcome of Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy

In Percutaneous Transluminal Septal Myocardial Ablation for Hypertrophic Obstructive Cardiomyopathy, It Is Not the Speed of Intracoronary Alcohol Injection But the Amount of Alcohol Injected That Determines the Resultant Infarct Size

How Can we Improve Non-Surgical Septal Reduction for Hypertrophic Obstructive Cardiomyopathy?

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