Abstract | OBJECTIVES: BACKGROUND: Anatomic variability of the vessels supplying the obstructing septal bulge can limit the efficacy of transcoronary ablation of septal hypertrophy in HOCM. Previous studies showed that inducing a local contraction disorder without reducing septal mass results in effective gradient reduction. We examined an alternative endocardial approach to transcoronary ablation of septal hypertrophy by using ERASH. METHODS: Nineteen patients with HOCM were enrolled; in 9 patients, the left ventricular septum was ablated, and in 10 patients, the right ventricular septum was ablated. Follow-up examinations (echocardiography, 6-min walk test, bicycle ergometry) were performed 3 days and 6 months after ERASH. RESULTS: After 31.2 ± 10 radiofrequency pulses, a significant and sustained LVOT gradient reduction could be achieved (62% reduction of resting gradients and 60% reduction of provoked gradients, p = 0.0001). The 6-min walking distance increased significantly from 412.9 ± 129 m to 471.2 ± 139 m after 6 months, p = 0.019); and New York Heart Association functional class was improved from 3.0 ± 0.0 to 1.6 ± 0.7 (p = 0.0001). Complete atrioventricular block requiring permanent pacemaker implantation occurred in 4 patients (21%); 1 patient had cardiac tamponade. CONCLUSIONS: ERASH is a new therapeutic option in the treatment of HOCM, allowing significant and sustained reduction of the LVOT gradient as well as symptomatic improvement with acceptable safety by inducing a discrete septal contraction disorder. It may be suitable for patients not amenable to transcoronary ablation of septal hypertrophy or myectomy.
|
Authors | Thorsten Lawrenz, Bianca Borchert, Christian Leuner, Markus Bartelsmeier, Jens Reinhardt, Claudia Strunk-Mueller, Dorothee Meyer Zu Vilsendorf, Marc Schloesser, Gerald Beer, Frank Lieder, Christoph Stellbrink, Horst Kuhn |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 57
Issue 5
Pg. 572-6
(Feb 01 2011)
ISSN: 1558-3597 [Electronic] United States |
PMID | 21272748
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
|
Copyright | Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Topics |
- Aged
- Aged, 80 and over
- Cardiomyopathy, Hypertrophic
(diagnosis, physiopathology, therapy)
- Catheter Ablation
(methods)
- Endocardium
(physiology)
- Exercise Test
(methods)
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Time Factors
|