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      Medical therapy versus interventional therapy in hypertropic obstructive cardiomyopathy

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          Abstract

          Medical treatment in symptomatic patients with hypertrophic obstructive cardiomyopathy aims to reduce the outflow tract gradients, and to improve diastolic dysfunction and rhythm disorders. Surgical myectomy is the standard treatment in patients with drug refractory symptoms. Since the early 1990s, dual-chamber (DDD)-pacemaker implantation and percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion have widened treatment options in this subgroup of patients. An overview of medical and interventional treatment is presented.

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          Efficacy of implantable cardioverter-defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy.

          Benoît G. Bardy, Steven Maron, Adrian Epstein … (2000)
          Hypertrophic cardiomyopathy is a genetic disease associated with a risk of ventricular tachyarrhythmias and sudden death, especially in young patients. We conducted a retrospective multicenter study of the efficacy of implantable cardioverter-defibrillators in preventing sudden death in 128 patients with hypertrophic cardiomyopathy who were judged to be at high risk for sudden death. At the time of the implantation of the defibrillator, the patients were 8 to 82 years old (mean [+/-SD], 40+/-16), and 69 patients (54 percent) were less than 41 years old. The average follow-up period was 3.1 years. Defibrillators were activated appropriately in 29 patients (23 percent), by providing defibrillation shocks or antitachycardia pacing, with the restoration of sinus rhythm; the average age at the time of the intervention was 41 years. The rate of appropriate defibrillator discharge was 7 percent per year. A total of 32 patients (25 percent) had episodes of inappropriate discharges. In the group of 43 patients who received defibrillators for secondary prevention (after cardiac arrest or sustained ventricular tachycardia), the devices were activated appropriately in 19 patients (11 percent per year). Of 85 patients who had prophylactic implants because of risk factors (i.e., for primary prevention), 10 had appropriate interventions (5 percent per year). The interval between implantation and the first appropriate discharge was highly variable but was substantially prolonged (four to nine years) in six patients. In all 21 patients with stored electrographic data and appropriate interventions, the interventions were triggered by ventricular tachycardia or fibrillation. Ventricular tachycardia or fibrillation appears to be the principal mechanism of sudden death in patients with hypertrophic cardiomyopathy. In high-risk patients with hypertrophic cardiomyopathy, implantable defibrillators are highly effective in terminating such arrhythmias, indicating that these devices have a role in the primary and secondary prevention of sudden death.
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            The management of hypertrophic cardiomyopathy.

            Barry J Maron, P Spirito, Randall W McKenna … (1997)
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              Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy.

              U Sigwart (1995)
              Surgery has been the only therapeutic option in patients with hypertrophic obstructive cardiomyopathy who are resistant to drug treatment and sequential pacemaker therapy. I describe a novel catheter-based technique that may replace surgical myocardial reduction in some patients. The technique aims at selective destruction of the hypertrophied part of the left side of the intraventricular septum. If temporary occlusion of the first major septal artery is shown to reduce the intraventricular pressure gradient significantly, absolute alcohol is injected through the inflated balloon catheter to produce a localised infarct. In the first three patients treated with this method, the size of the septal infarct was sufficient to eliminate any subaortic stenosis immediately. Clinical improvement has been maintained up to 12 months. Non-surgical reduction of the septum in hypertrophic obstructive cardiomyopathy warrants further clinical evaluation.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Curr Control Trials Cardiovasc Med
                Title: Current Controlled Trials in Cardiovascular Medicine
                Publisher: BioMed Central
                ISSN (Print): 1468-6708
                ISSN (Electronic): 1468-6694
                Publication date (Print): 2000
                Publication date (Electronic): 11 October 2000
                Volume: 1
                Issue: 2
                Pages: 115-119
                Affiliations
                [1 ]Leopoldina-Krankenhaus, Schweinfurt, Germany
                Article
                Publisher ID: cvm-1-2-115
                DOI: 10.1186/cvm-1-2-115
                PMC ID: 59612
                PubMed ID: 11714423
                SO-VID: 61b6ecc4-6665-4a7e-9544-c91039152c82
                Copyright © Copyright © 2000 Current Controlled Trials Ltd
                History
                Date received : 18 July 2000
                Date accepted : 20 September 2000
                Categories
                Subject: Review

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: remodeling,hypertrophic obstructive cardiomyopathy,percutaneous septal ablation
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: remodeling, hypertrophic obstructive cardiomyopathy, percutaneous septal ablation

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