PERCUTANEOUS TRANSLUMINAL SEPTAL MYOCARDIAL ABLATION IN HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY - ACUTE RESULTS AND 3-MONTH FOLLOW-UP IN 25PATIENTS

Objectives. We report the acute results and midterm clinical course af ter percutaneous transluminal septal myocardial ablation (PTSMA) in sy mptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) , Background. In the treatment of HOCM, surgical myectomy and DDD pace maker therapy are considered the standard procedural extensions to dru g therapy with negatively inotropic drugs, As an alternative nonsurgic al procedure for reducing the left ventricular outflow tract (LVOT) gr adient, PTSMA by alcohol-induced septal branch occlusion was introduce d, However, clinical follow up has not been sufficiently described, Me thods. In 25 patients (13 women, 12 men; mean [+/-SD] age 54.7 +/- 15. 0 years) who were symptomatic despite sufficient drug therapy, 1.4 +/- 0.6 septal branches were occluded with an injection of 4.1 +/- 2.6 mi of alcohol (96%) to ablate the hypertrophied interventricular septum, After 3-months, follow-up results of LVOT gradients and clinical cour se were determined, Results. The invasively determined LVOT gradients could be reduced in 22 patients (88%), with a mean reduction from 61.8 +/- 29.8 mm Hg (range 4 to 152) to 19.4 +/- 20.8 mm Hg (range 0 to 74 ) at rest (p < 0.0001) and from 141.4 +/- 45.3 mm Hg (range 76 to 240) to 61.1 +/- 40.1 mm Hg (range 0 to 135) after extrasystole, All patie nts had angina pectoris for 24 h, The maximal creatine kinase increase was 780 +/- 436 U/liter (range 305 to 1,810) after 11.1 +/- 6.0 h (ra nge 4 to 24), Thirteen patients (52%) developed a trifascicular block for 5 min to 8 days requiring temporary (n = 8 [32%]) or permanent (DD D) pacemaker implantation (n = 5 [20%]), An 86-year old woman died 8 d ays after successful intervention of uncontrollable ventricular fibril lation in conjunction with beta-sympathomimetics in chronically obstru ctive pulmonary disease, The remaining patients were discharged after 11.3 +/- 5.4 days (range 5 to 24), after an uncomplicated hospital cou rse. Clinical and echocardiographic follow-up was achieved in all 24 s urviving patients after 3 months, No cardiac complications occurred, T wenty-one patients (88%) showed clinical improvement, with a New York Heart Association functional class of 1.4 +/- 1.1, A further reduction in LVOT gradient was shown in 14 patients (58%), Conclusions. PTSMA o f HOCM is a promising nonsurgical technique for septal myocardial redu ction, with a consecutive reduction in LVOT gradient, Possible complic ations are trifascicular blocks, requiring permanent pacemaker implant ation, and tachycardiac rhythm disturbances, Clinical long-term observ ations of larger patient series and a comparison with conventional for ms of therapy are necessary to determine the conclusive therapeutic si gnificance. (C) 1998 by the American College of Cardiology.