Septal ablation for hypertrophic cardiomyopathy: to whom, when, and how?

Abstract

Patient selection for percutaneous transluminal septal myocardial ablation (indications and contraindications) • Technique for percutaneous transluminal septal myocardial ablation • Complications and follow-up after percutaneous transluminal septal myocardial ablation • Results of percutaneous transluminal septal myocardial ablation • SummaryHypertrophic cardiomyopathy (HCM) is a genetic cardiac disease with heterogeneous clinical course and expression. The clinical course is variable, and patients may remain stable over long periods without any symptoms; however the course of some patients may be punctuated by adverse clinical events, such as sudden death, stroke, chest pain, and heart failure.1,2A fundamental goal of treatment in HCM is the alleviation of symptoms related to heart failure. Medical therapy with beta-blockers, verapamil, and disopyramide has been the initial therapeutic approach for relieving symptoms. Unfortunately, in about 10% of patients with left ventricle outflow obstruction, severe symptoms are unresponsive to medical therapy.3 For these patients, surgical therapy has been the cornerstone of treatment for decades, with a reported mortality of < 2% in highly experienced centers.4-6The idea of a percutaneous septal ablation was first considered in the 1980s. Percutaneous transluminal septal myocardial ablation (PTSMA) aims to reduce left ventricle outflow tract gradient by reducing the interventricular septum thickness through alcohol-induced occlusion of a septal branch, resulting with a circumscribed infarction.7 The first successful PTSMA was reported by Sigwart,8 and this technique has gained great popularity in the past few years, especially in European countries.