Current Status and Future Perspectives on Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

Khouzam, Rami N.; Naidu, Srihari S.

doi:10.1007/s11886-014-0478-3

Cited by 12 publications

(7 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Most of HCM patients who undergo myectomy, develop left bundle branch block, and approximately a quarter of HCM patients who underwent alcohol septal ablation develop complete heart block. 29 Few case reports showed that a scar formed after alcohol septal ablation could serve as a substrate for reentrant VT 30 . Thus, surgical HCM treatment may reduce heart failure symptoms but do not change SCD risk in HCM.…”

Section: Ep Substrate and Mechanisms Of Arrhythmogenesis In Hcmmentioning

confidence: 99%

Mechanisms of Arrhythmogenicity in Hypertrophic Cardiomyopathy: Insight from Noninvasive Electrocardiographic Imaging

Alday

Haq

German

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: Mechanisms of arrhythmogenicity in hypertrophic cardiomyopathy (HCM) are not well understood. We hypothesized that HCM is characterized by the specific electrophysiological substrate as compared to patients with ischemic cardiomyopathy (ICM), or healthy individuals. Methods: We conducted a prospective case-control study. The study enrolled HCM patients at high risk for ventricular tachyarrhythmia (VT) (n=10; age 61±9 y; left ventricular ejection fraction (LVEF) 60±9%), and three comparison groups: healthy individuals (n=10; age 28±6 y; LVEF>70%), ICM patients with LV hypertrophy (LVH) and known VT (n=10; age 64±9 y; LVEF 31±15%), and ICM patients with LVH and no known VT (n=10; age 70 ± 7y; LVEF 46±16%). All participants underwent 12-lead ECG, cardiac CT or MRI, and 128-electrode body surface mapping (BioSemi ActiveTwo, Netherlands). Non-invasive voltage and activation maps were reconstructed using the open-source SCIRun (University of Utah) inverse problem-solving environment. Results: In the epicardial basal anterior segment, HCM patients had the greatest ventricular activation dispersion [16.4±5.5 vs. 13.1±2.7 (ICM with VT) vs. 13.8±4.3 (ICM no VT) vs. 8.1±2.4 ms (Healthy); P=0.0007], the largest unipolar voltage [1094±211 vs. 934±189 (ICM with VT) vs. 898±358 (ICM no VT) vs. 842±90 μV (Healthy); P=0.023], and the greatest voltage dispersion [median(interquartile range) 215(161-281) vs. 189(143-208) (ICM with VT) vs. 158(109-236) (ICM no VT) vs. 110(106-168)μV (Healthy); P=0.041]. Differences were also observed in other endo-and epicardial basal and apical segments. Conclusion: HCM is characterized by a greater activation dispersion in basal segments, a larger voltage, and a larger voltage dispersion through LV.

show abstract

Section: Ep Substrate and Mechanisms Of Arrhythmogenesis In Hcmmentioning

confidence: 99%

Mechanisms of Arrhythmogenicity in Hypertrophic Cardiomyopathy: Insight from Noninvasive Electrocardiographic Imaging

Alday

Haq

German

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…The gradients at rest and with provocation are recorded again. Some operators advocate occlusion of other septal branches in the same session if the gradient reduction is suboptimal [ 51 ]. If the opacified area in echocardiography after alcohol injection is satisfactory, we tend to await the haemodynamic effect after 3-6 months, as remodelling and scar formation can lead to further gradient reduction at follow-up [ 34 ].…”

Section: Techniquementioning

confidence: 99%

Twenty Years of Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy

Rigopoulos

Seggewiß²

2016

CCR

View full text Add to dashboard Cite

Hypertrophic obstructive cardiomyopathy is the most common genetic cardiac disease and is generally characterised by asymmetric septal hypertrophy and intraventricular obstruction. Patients with severe obstruction and significant symptoms that persist despite optimal medical treatment are candidates for an invasive septal reduction therapy. Twenty years after its introduction, percutaneous transluminal alcohol septal ablation has been increasingly preferred for septal reduction in patients with drug refractory hypertrophic obstructive cardiomyopathy. Myocardial contrast echocardiography and injection of reduced alcohol volumes have increased safety, while efficacy is comparable to the surgical alternative, septal myectomy, which has for decades been regarded as the ‘gold standard’ treatment. Data on medium- and long-term survival show improved prognosis with survival being similar to the general population. Current guidelines have supported its use by experienced operators in centres specialised in the treatment of patients with hypertrophic obstructive cardiomyopathy.

show abstract

“… 8 , 96 Surgical myectomy and alcohol ablation are generally used to relieve left ventricular obstruction in severely symptomatic patients. 4 , 5 , 8 On the other hand, implantation of an internal cardioverter defibrillator is generally considered for termination of life-threatening arrhythmias, avoiding the possibility of sudden cardiac death and hence extending the lifespan of the patient. 5 HCM patients with atrial fibrillation are generally treated with anticoagulation agents to avoid thromboembolism, and can also be considered for pulmonary vein isolation, pacemaker implantation, or a surgical Maze procedure.…”

Section: Therapeutics For Hypertrophic Cardiomyopathymentioning

confidence: 99%

“… 3 HCM, a primary disease of the cardiac muscle that occurs mainly due to mutations in genes encoding for the cardiac contractile apparatus, is the most common familial form of cardiomyopathy, as well as the most phenotypically variable cardiac disease. 4 – 6 Indeed, the pathophysiology of HCM is complex, being characterized by a wide range of disease processes, with varying genetics, clinical manifestations, heart morphology, and prognosis. 6 Due to the phenotypic heterogeneity of the disease, the diagnosis of HCM at late adulthood is frequent, when the morphology and functional debility of the heart caused by the disease have progressed.…”

Section: Introductionmentioning

confidence: 99%

Genetics of hypertrophic cardiomyopathy: advances and pitfalls in molecular diagnosis and therapy

Roma‐Rodrigues¹,

Fernandes²

2014

TACG

View full text Add to dashboard Cite

Hypertrophic cardiomyopathy (HCM) is a primary disease of the cardiac muscle that occurs mainly due to mutations (>1,400 variants) in genes encoding for the cardiac sarcomere. HCM, the most common familial form of cardiomyopathy, affecting one in every 500 people in the general population, is typically inherited in an autosomal dominant pattern, and presents variable expressivity and age-related penetrance. Due to the morphological and pathological heterogeneity of the disease, the appearance and progression of symptoms is not straightforward. Most HCM patients are asymptomatic, but up to 25% develop significant symptoms, including chest pain and sudden cardiac death. Sudden cardiac death is a dramatic event, since it occurs without warning and mainly in younger people, including trained athletes. Molecular diagnosis of HCM is of the outmost importance, since it may allow detection of subjects carrying mutations on HCM-associated genes before development of clinical symptoms of HCM. However, due to the genetic heterogeneity of HCM, molecular diagnosis is difficult. Currently, there are mainly four techniques used for molecular diagnosis of HCM, including Sanger sequencing, high resolution melting, mutation detection using DNA arrays, and next-generation sequencing techniques. Application of these methods has proven successful for identification of mutations on HCM-related genes. This review summarizes the features of these technologies, highlighting their strengths and weaknesses. Furthermore, current therapeutics for HCM patients are correlated with clinically observed phenotypes and are based on the alleviation of symptoms. This is mainly due to insufficient knowledge on the mechanisms involved in the onset of HCM. Tissue engineering alongside regenerative medicine coupled with nanotherapeutics may allow fulfillment of those gaps, together with screening of novel therapeutic drugs and target delivery systems.

show abstract

Current Status and Future Perspectives on Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

Cited by 12 publications

References 30 publications

Mechanisms of Arrhythmogenicity in Hypertrophic Cardiomyopathy: Insight from Noninvasive Electrocardiographic Imaging

Mechanisms of Arrhythmogenicity in Hypertrophic Cardiomyopathy: Insight from Noninvasive Electrocardiographic Imaging

Twenty Years of Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy

Genetics of hypertrophic cardiomyopathy: advances and pitfalls in molecular diagnosis and therapy

Contact Info

Product

Resources

About