Alcohol Septal Ablation Versus Surgical Myectomy in Hypertrophic Obstructive Cardiomyopathy

Abstract

The surgical myomectomy for hypertrophied myocardium in patients with HOCM is a well-established and evidence-based treatment modality. However, with the drawback of exposing the patient to major surgery and prolonged post-operative periods, cardiologists together with their surgical peers found the advent of a potentially less invasive procedure. This has been accomplished by the installation of alcohol through the coronary arteries in order to shrink the diseased and hypertrophied muscle area with an aim to alleviate the symptoms in the first instance if not completely curing the pathology as an endeavor goal. Nevertheless, with this invention, a few complications have started to emerge. The main drawback was heart block, which could require permanent pacemaker insertion in most of the cases. In the interim, there is no clear pathway or guideline to decide which treatment option would be the best, and there is no certain inclusion or exclusion criteria incorporate patients who can undergo either one of the modalities. In this review, four studies were scrutinized to investigate the major consequences of each route, especially focusing on the proportion of complete heart block. Also, the role of MRI in the delineation of the resected area either surgically or by alcohol administration is studied in detail. After reviewing these articles, it has been concluded that despite alcohol septal ablation being less invasive approach, surgical therapy remains the preferred treatment modality and it is preferred treatment modality and so far, it is the gold standard option in the management of hypertrophic obstructive cardiomyopathy. Nevertheless, it could not be overlooked the lack of strong RCTS in such area which could be one of the main points that future trialists need to consider.