In percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy, it is not the speed of intracoronary alcohol injection but the amount of alcohol injected that determines the resultant infarct size.

Abstract

To the Editor: In the Clinician Update on percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM), Kimmelstiel and Maron1 presented a successfully treated patient with maintenance of benefit 6 months later. The authors emphasized the importance of using smaller amounts of alcohol and injecting it more slowly into the first septal branch of the left anterior descending coronary artery to create more limited areas of myocardial infarction. According to the experimental study reported recently by my colleagues in China and me,2 the size of the iatrogenic myocardial infarct is directly related to the amount of intracoronary alcohol injection during PTSMA but has no relation to its speed of injection. This study was carried out in piglets. It found significant differences in myocardial infarct size with different amounts of alcohol injected but no apparent differences in myocardial infarct size with different speeds of alcohol injection. …