Skip to main content
Log in

Long-term follow-up after percutaneous septal ablation in hypertrophic obstructive cardiomyopathy

  • ORIGINAL PAPER
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Objectives

The aim of this study was to evaluate the longterm follow-up results of percutaneous transluminal septal myocardial ablation (PTSMA) in a large patient cohort.

Background

PTSMA by alcohol injection into septal branches has shown good acute and short-term results in symptomatic patients with hypertrophic obstructive cardiomyopathy.

Methods

A total of 100 consecutive symptomatic (NYHA class 2.8 ± 0.6) patients underwent PTSMA. All patients had clinical and non-invasive follow-up at 3 months, 1 year, and annually up to 8 years.

Results

One patient died at day 2 after intervention due to fulminant pulmonary embolism following deep venous thrombosis, and eight patients required a permanent DDD-pacemaker due to post-interventional complete heart block. Acute reduction of the left ventricular outflow tract gradient was achieved from 76 ± 37 to 19 ± 21 mmHg at rest, from 104 ± 34 to 43 ± 31 mmHg during Valsalva maneuver, and from 146 ± 45 to 59 ± 42 mmHg post extrasystole (p < 0.0001, each). During follow-up (mean follow-up time: 58 ± 14 months), three additional patients died (sudden death at 48 months, non-cardiac death at 49 months and stroke-related death at 60 months after the index procedure). All living patients showed clinical improvement to NYHA-class 1.4 ± 0.6 (after 3 months, n = 99), 1.5 ± 0.6 (after 1 year, n = 99), and 1.6 ± 0.7 at final follow-up (n = 96; p < 0.0001, each). Non-invasive follow-up studies documented ongoing outflow tract gradient reduction, decrease of septal and left ventricular posterior wall thickness, and improvement of exercise capacity.

Conclusions

PTSMA is an effective treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy. Follow-up showed ongoing hemodynamic and clinical improvement without increased mortality and morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wigle ED, Rakowski H, Kimball BP, Williams WG (1995) Hypertrophic cardiomyopathy. Clinical spectrum and treatment. Circulation 92:1680– 1692

    PubMed  CAS  Google Scholar 

  2. Maron BJ, McKenna WJ, Danielson GK et al (2003) American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines. J Am Coll Cardiol 42:1687–1713

    Article  PubMed  Google Scholar 

  3. Spirito P, Seidman CE, McKenna WJ, Maron BJ (1997) The management of hypertrophic cardiomyopathy. N Engl J Med 336:775–785

    Article  PubMed  CAS  Google Scholar 

  4. Schoendube FA, Klues HG, Reith S, Flachskampf FA, Hanrath P, Messmer BJ (1995) Long-term clinical and echocardiographic follow-up after surgical correction of hypertrophic obstructive cardiomyopathy with extended myectomy and reconstruction of the subvalvular mitral apparatus. Circulation 92:II122–127

    PubMed  CAS  Google Scholar 

  5. Schulte HD, Gramsch-Zabel H, Schwartzkopff B (1995) Hypertrophe obstruktive Kardiomyopathie: Chirurgische Behandlung. Hypertrophic obstructive cardiomyopathy: surgical treatment. Schweiz Med Wochenschr 125:1940–1949

    PubMed  CAS  Google Scholar 

  6. Heric B, Lytle BW, Miller DP, Rosenkranz ER, Lever HM, Cosgrove DM (1995) Surgical management of hypertrophic obstructive cardiomyopathy. Early and late results. J Thorac Cardiovasc Surg 110:195–206 (discussion 206–208)

    Article  PubMed  CAS  Google Scholar 

  7. Woo A, Williams WG, Choi R et al (2005) Clinical and echocardiographic determinants of long-term survival after surgical myectomy in obstructive hypertrophic cardiomyopathy. Circulation 111:2033–2041

    Article  PubMed  Google Scholar 

  8. Maron BJ, Nishimura RA, McKenna WJ, Rakowski H, Josephson ME, Kieval RS (1999) Assessment of permanent dual-chamber pacing as a treatment for drug-refractory symptomatic patients with obstructive hypertrophic cardiomyopathy. A randomized, double-blind, crossover study (M-PATHY). Circulation 99:2927–2933

    PubMed  CAS  Google Scholar 

  9. Sigwart U (1995) Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy. Lancet 346:211–214

    Article  PubMed  CAS  Google Scholar 

  10. Gleichmann U, Seggewiss H, Faber L, Fassbender D, Schmidt HK, Strick S (1996) Kathetertherapie der hypertrophen obstruktiven Kardiomyopathie. Catheter treatment of hypertrophic obstructive cardiomyopathy. Dtsch Med Wochenschr 121:679–685

    PubMed  CAS  Google Scholar 

  11. Seggewiss H, Gleichmann U, Faber L, Fassbender D, Schmidt HK, Strick S (1998) Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: acute results and 3-month follow-up in 25 patients. J Am Coll Cardiol 31:252–258

    Article  PubMed  CAS  Google Scholar 

  12. Faber L, Seggewiss H, Gleichmann U (1998) Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: results with respect to intraprocedural myocardial contrast echocardiography. Circulation 98:2415–2421

    PubMed  CAS  Google Scholar 

  13. Knight C, Kurbaan AS, Seggewiss H et al (1997) Nonsurgical septal reduction for hypertrophic obstructive cardiomyopathy: outcome in the first series of patients. Circulation 95:2075–2081

    PubMed  CAS  Google Scholar 

  14. Nagueh SF, Lakkis NM, He ZX et al (1998) Role of myocardial contrast echocardiography during nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 32:225–229

    Article  PubMed  CAS  Google Scholar 

  15. Gietzen FH, Leuner CJ, Raute-Kreinsen U et al (1999) Acute and longterm results after transcoronary ablation of septal hypertrophy (TASH). Catheter interventional treatment for hypertrophic obstructive cardiomyopathy. Eur Heart J 20:1342–1354

    Article  PubMed  CAS  Google Scholar 

  16. Sahn D, De Maria A, Kisslo J, Weyman A (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. The committee on M-mode standardization of the American Society of Echocardiography. Circulation 58:1072–1083

    PubMed  CAS  Google Scholar 

  17. Pollick C, Rakowski H, Wigle ED (1984) Muscular subaortic stenosis: the quantitative relationship between systolic anterior motion and the pressure gradient. Circulation 69:43–49

    PubMed  CAS  Google Scholar 

  18. Seggewiss H (2001) Current status of alcohol septal ablation for patients with hypertrophic cardiomyopathy. Curr Cardiol Rep 3:160–166

    Article  PubMed  CAS  Google Scholar 

  19. Elliott PM, Poloniecki J, Dickie S et al (2000) Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. J Am Coll Cardiol 36:2212–2218

    Article  PubMed  CAS  Google Scholar 

  20. Qin JX, Shiota T, Lever HM et al (2001) Outcome of patients with hypertrophic obstructive cardiomyopathy after percutaneous transluminal septal myocardial ablation and septal myectomy surgery. J Am Coll Cardiol 38:1994–2000

    Article  PubMed  CAS  Google Scholar 

  21. Firoozi S, Elliott PM, Sharma S et al (2002) Septal myotomy-myectomy and transcoronary septal alcohol ablation in hypertrophic obstructive cardiomyopathy. A comparison of clinical, haemodynamic and exercise outcomes. Eur Heart J 23:1617–1624

    Article  PubMed  CAS  Google Scholar 

  22. Lakkis NM, Nagueh SF, Dunn JK, Killip D, Spencer WH 3rd (2000) Nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy: one-year follow-up. J Am Coll Cardiol 36:852–855

    Article  PubMed  CAS  Google Scholar 

  23. Faber L, Meissner A, Ziemssen P, Seggewiss H (2000) Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy: long term follow up of the first series of 25 patients. Heart 83:326–331

    Article  PubMed  CAS  Google Scholar 

  24. Schulz-Menger J, Strohm O, Waigand J, Uhlich F, Dietz R, Friedrich MG (2000) The value of magnetic resonance imaging of the left ventricular outflow tract in patients with hypertrophic obstructive cardiomyopathy after septal artery embolization. Circulation 101:1764–1766

    PubMed  CAS  Google Scholar 

  25. Curtius JM, Stoecker J, Loesse B, Welslau R, Scholz D (1989) Changes of the degree of hypertrophy in hypertrophic obstructive cardiomyopathy under medical and surgical treatment. Cardiology 76:255–263

    Article  PubMed  CAS  Google Scholar 

  26. Rivera S, Sitges M, Azqueta M et al (2003) Left ventricular remodeling in patients with hypertrophic obstructive cardiomyopathy treated with percutaneous alcohol septal ablation: an echocardiographic study. Rev Esp Cardiol 56:1174–1181

    Article  PubMed  Google Scholar 

  27. Maron BJ (1999) New interventions for obstructive hypertrophic cardiomyopathy: promise and prudence. Eur Heart J 20:1292–1294

    Article  PubMed  CAS  Google Scholar 

  28. Frenneaux MP, Counihan PJ, Caforio AL, Chikamori T, McKenna WJ (1990) Abnormal blood pressure response during exercise in hypertrophic cardiomyopathy. Circulation 82:1995–2002

    PubMed  CAS  Google Scholar 

  29. Raute-Kreinsen U (2003) Morphology of necrosis and repair after transcoronary ethanol ablation of septal hypertrophy. Pathol Res Pract 199:121–127

    Article  PubMed  Google Scholar 

  30. Maron MS, Olivotto I, Betocchi S et al (2003) Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med 348:295–303

    Article  PubMed  Google Scholar 

  31. Faber L, Welge D, Fassbender D, Schmidt HK, Horstkotte D, Seggewiss H (2007) One-year follow-up of percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy in 312 patients: predictors of haemodynamic and clinical response. Clin Res Cardiol (in press)

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hubert Seggewiss MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Seggewiss, H., Rigopoulos, A., Welge, D. et al. Long-term follow-up after percutaneous septal ablation in hypertrophic obstructive cardiomyopathy. Clin Res Cardiol 96, 856–863 (2007). https://doi.org/10.1007/s00392-007-0579-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-007-0579-8

Key words

Navigation