Role of Transcoronary Ablation of Septal Hypertrophy in Patients With Hypertrophic Cardiomyopathy, New York Heart Association Functional Class III or IV, and Outflow Obstruction Only Under Provocable Conditions

Abstract

Background-Transcoronary ablation of septal hypertrophy (TASH) for hypertrophic cardiomyopathy seems to be an effective alternative to surgical myectomy. It remains a point of debate whether an outflow obstruction at rest is a necessary criterion for interventional therapy.

Outcome of Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy

“…4 -11 Percutaneous alcohol septal ablation has emerged as a potentially less invasive, alternative mode of treatment and is increasingly being performed in a number of cardiac centers worldwide. [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.…”

Role of Percutaneous Septal Ablation in Hypertrophic Obstructive Cardiomyopathy

“…1,3 There has been considerable interest over the past few years in a percutaneous method for relieving obstruction and symptoms that has been referred to in the literature by several names and acronyms. [3][4][5][6][7][8][9] This procedure uses conventional interventional methodology currently available for treating atherosclerotic coronary artery disease to create necrosis of the anterior basal septum by introducing absolute alcohol directly into a proximal septal perforator artery, ultimately reducing LV wall thickness, enlarging the outflow tract and reducing mechanical impedance to LV ejection. Therefore, percu-taneous transluminal septal myocardial ablation (PTSMA) may mimic the morphological and hemodynamic effects of surgical myectomy.…”

“…The immediate postablation gradient reduction is probably due to alcohol-mediated septal necrosis and stunning, a mechanism distinct from the septal thinning and ventricular remodeling that is associated with progressive gradient reduction on long-term follow-up. [5][6][7][8][9] Clinical Results…”

“…8 Patients with predominant provocable obstruction may also benefit from PTSMA. 9 Although reports of symptomatic benefit after PTSMA have been based largely on retrospective and uncontrolled assessments, some objective data are now available describing clinical improvement in terms of measured exercise capacity by treadmill exercise time and peak oxygen consumption. Significant and progressive enhancement in exercise treadmill time or maximum workload or peak oxygen consumption have been reported to be associated with gradient reduction in follow-up studies over 3 to 18 months.…”

“…4,6,10 PTSMArelated mortality has been reported at up to 4%, but in experienced centers is currently 1% to 2% (similar to that of surgery). [7][8][9] Conduction abnormalities are relatively common complications of PTSMA, with permanent right bundle branch block and transitory heart block in about 50% and high-grade atrioventricular block requiring permanent pacemakers in 5% to 20%. Particular concern regarding complete heart block relates to its occasional unheralded occurrence after PTSMA, mandating inpatient monitoring for 4 to 5 days.…”