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Transcatheter septal ablation in hypertrophic obstructive cardiomyopathy: a technical guide and review of published results

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Abstract

Transcatheter alcohol septal ablation (ASA) treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) is based on the existence and degree of intraventricular obstruction. Patients with significant gradient and symptoms who do not respond to optimal medical therapy are eligible to gradient reduction through a surgical (septal myectomy) or a transcatheter (alcohol septal ablation) septal reduction. The latter encompasses occlusion of a septal branch perfusing the hypertrophied septum, which is involved in the generation of obstruction, by injecting ethanol into the supplying septal branch(es). ASA has been established as a highly effective and safe method and has outnumbered the surgical gold standard. Although the technique is straightforward, patient selection and some technical details may influence the efficacy and safety of the procedure. The technique is based on echocardiographic contrast guidance, which allows accurate target septal branch selection and optimisation of the result. Published long-term results from high-volume centres have confirmed the effectiveness of ASA and have shown excellent survival, which is comparable to that in the general population. Choice and performance of the surgical or interventional treatment should be implemented in highly specialised centres in terms of a heart-team approach, taking notice of anatomic characteristics as well as comorbidities. Involvement of all cases in international registries may reveal the individual merits and indications for the surgical and interventional treatment in HOCM.

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Abbreviations

ASA:

Alcohol septal ablation

AV:

Atrioventricular

AHA:

American Heart Association

CMR:

Cardiac magnetic resonance

ESC:

European Society of Cardiology

HCM:

Hypertrophic cardiomyopathy

HOCM:

Hypertrophic obstructive cardiomyopathy

ICD:

Implantable cardioverter defibrillator

LAD:

Left anterior descending (coronary artery)

LV:

Left ventricular

LVOT:

Left ventricular outflow tract obstruction

LVOTO:

Left ventricular outflow tract obstruction

NIS:

National (Nationwide) Inpatient Sample

PCI:

Percutaneous coronary intervention

RAO:

Right anterior oblique

SAM:

Systolic anterior motion

SCD:

Sudden cardiac death

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Authors and Affiliations

  1. Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Strasse 40, D-06120, Halle, Germany

    Angelos G. Rigopoulos, Stefanos Sakellaropoulos, Muhammad Ali & Michel Noutsias

  2. Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61, Palaeo Faliro, Athens, Greece

    Sophie Mavrogeni

  3. Interventional Cardiology and Cardiology Department, Mediterraneo Hospital, Ilias Street 8-12, 16675, Glyfada, Greece

    Athanassios Manginas

  4. Department of Cardiology, Internal Medicine 8, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany

    Matthias Pauschinger

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  1. Angelos G. Rigopoulos
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  2. Stefanos Sakellaropoulos
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  3. Muhammad Ali
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  4. Sophie Mavrogeni
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Correspondence to Angelos G. Rigopoulos.

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Potential conflicts of interest

M.N. has received grants by the Deutsche Forschungsgemeinschaft (DFG) through the Sonderforschungsbereich Transregio 19 ‘Inflammatory Cardiomyopathy’ (SFB TR19) (TP B2), and by the University Hospital Giessen and Marburg Foundation Grant ‘T cell functionality’ (UKGM 10/2009). MP has received a grant by the DFG (SFB TR19 TP A2). M.N. has been consultant to the IKDT (Institute for Cardiac Diagnosis and Therapy GmbH, Berlin) 2004–2008 and has received honoraria for presentations and/or participated in advisory boards from AstraZeneca, Bayer, Boehringer Ingelheim, Fresenius, Miltenyi Biotech, Novartis, Pfizer and Zoll.

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Rigopoulos, A.G., Sakellaropoulos, S., Ali, M. et al. Transcatheter septal ablation in hypertrophic obstructive cardiomyopathy: a technical guide and review of published results. Heart Fail Rev 23, 907–917 (2018). https://doi.org/10.1007/s10741-018-9706-z

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