Copyright © 1999 by the European Society of Cardiology.
Acute and long-term results after transcoronary ablation of septal hypertrophy (TASH). Catheter interventional treatment for hypertrophic obstructive cardiomyopathy
a Department of Internal Medicine II—Cardiology Section, Bielefeld Hospital, Academic Teaching Hospital of the University of Münster, Bielefeld, Germany
b Institute of Pathology, Bielefeld Hospital, Academic Teaching Hospital of the University of Münster, Bielefeld, Germany
revised January 8, 1999; accepted January 15, 1999
Abstract
Aims To evaluate acute and long-term symptomatic, haemodynamic (at rest and during exercise) and electrophysiological results of transcoronary ablation of septal hypertrophy (TASH), a catheter interventional treatment for hypertrophic obstructive cardiomyopathy.
Methods and Results Sixty-two transcoronary ablations of septal hypertrophy were performed by injection of 4·6±2·6ml 96% ethanol into septal branches in 50 patients with hypertrophic obstructive cardiomyopathy and severe symptoms. Serial left and right heart catheterization, transoesophageal echocardiography and electrophysiological investigations were repeated 2 weeks and 7±1 months (n=37) after intervention. Transcoronary ablation of septal hypertrophy led to a reduction in septal thickness, sustained elimination of the outflow obstruction (51±41 vs 6±10mmHg at rest, P<0·001; 134±48 vs 28±32mmHg, P<0·001, post-extrasystolic), a decrease in left ventricular filling pressures at rest and during exercise and a pronounced clinical improvement. There was no evidence for the creation of an arrhythmogenic substrate as assessed by serial programmed electrical stimulation in 39 patients. However, permanent high-grade atrioventricular block occurred in 17% of the patients. There were two early, but no late deaths during a mean follow-up time of 10·6±5·6 months.
Conclusion Transcoronary ablation of septal hypertrophy is a promising new treatment for hypertrophic obstructive cardiomyopathy in patients with severe symptoms. It should now be compared with alternative treatment strategies in prospective randomized studies.
Key Words: Therapy of hypertrophic obstructive cardiomyopathy, catheter interventional therapy, cardiac hypertrophy, effect of ethanol
f1 Correspondence : Dr Frank H. Gietzen, Medizinische Klinik II, Staedtische Kliniken Bielefeld-Mitte, Teutoburgerstr. 50, D-33604 Bielefeld, Germany.
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