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Septal reduction therapy is appropriate for patients with hypertrophic obstructive cardiomyopathy (HOCM) who have symptoms that are refractory to optimal medical therapy, and that interfere importantly enough with lifestyle that patients are willing to assume the risks of invasive procedures.
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Given the overall comparable outcomes after septal ablation and septal myectomy, for many patients, there is equipoise between the two procedures.
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Septal ablation is performed with standard angioplasty
Choice of Septal Reduction Therapies and Alcohol Septal Ablation
Section snippets
Key points
Patient selection for septal reduction therapy
In most symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM), symptoms are adequately controlled with negative inotropic medications (ß-blockers, calcium channel blockers, and disopyramide) alone or in combination.1, 2 In patients with HOCM and symptoms refractory to optimal medical therapy, septal reduction therapy (SRT) with either alcohol septal ablation or surgical septal myectomy may be considered.
The 2011 American College of Cardiology Foundation (ACCF)/American Heart
Concomitant Cardiac Conditions
In some cases, HOCM is associated with intrinsic abnormalities of the mitral valve. These and other patients who require concomitant valve surgery or coronary bypass grafting should undergo septal myectomy rather than septal ablation. Surgery should also be considered for patients with atrial fibrillation who might benefit from a concomitant maze procedure.
Concomitant Noncardiac Conditions
Comorbidities, such as lung and liver disease, generally increase the risk of cardiac surgery more than the risk of interventional
Initial Septal Ablation Procedures
Transcatheter ablation of the septum with ethanol was introduced by Sigwart in 1994 at Royal Brompton Hospital.22 The first patient had labile LVOT obstruction and severe symptoms despite ß-blockade. Peak creatine kinase was 2500 U/L. She was discharged 3 days after septal ablation, and was asymptomatic 10 months later.
Indications
Indications for septal ablation are summarized in Box 2.
Technique
Because atrioventricular block constitutes the major morbidity of septal ablation, temporary pacemaker placement is
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Cited by (6)
Alcohol dose in septal ablation for hypertrophic obstructive cardiomyopathy
2021, International Journal of CardiologyCitation Excerpt :Additionally, the extent of post-ASA myocardial scar tissue should not induce significant arrhythmogenic events or heart failure. It is important to note, however, that apart from the amount of injected alcohol, a range of factors including, for example, anatomy of the septal branches, mechanism of subaortic dynamic obstruction and interplay with the mitral apparatus, papillary muscles abnormalities, magnitude of septal thickness, and septal hypertrophy geometry play important roles in decision-making to tailor optimal therapy for each individual HOCM patient [21–25]. Since these and other unmeasured factors were not taken into account in our study it is impossible to establish a specific alcohol dose suitable for all HOCM patients treated with ASA.
Relieved by the alcohol
2019, Revista Portuguesa de CardiologiaAlcohol septal ablation versus surgical septal myectomy of obstructive hypertrophic cardiomyopathy: systematic review and meta-analysis
2023, European Journal of Cardio-thoracic SurgeryPredictors of cardiovascular implantable electronic device dependence at long-term follow-up after alcohol septal ablation in hypertrophic cardiomyopathy patients
2023, Journal of Interventional Cardiac ElectrophysiologyContemporary Therapies and Future Directions in the Management of Hypertrophic Cardiomyopathy
2022, Cardiology and Therapy
Disclosure Statement: Dr M.A. Fifer serves on the Scientific Advisory Board of MyoKardia, Inc.