This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Henein, M. Y. Articles by Gibson, D. G. Search for Related Content PubMed PubMed Citation Articles by Henein, M. Y. Articles by Gibson, D. G.

CLINICAL STUDIES

Electromechanical left ventricular behavior after nonsurgical septal reduction in patients with hypertrophic obstructive cardiomyopathy

^a Royal Brompton Hospital, London, United Kingdom

Manuscript received October 23, 1998; revised manuscript received May 5, 1999, accepted June 22, 1999.

Reprint requests and correspondence: Dr. Derek G. Gibson, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom
m.henein{at}rbh.nthame.nhs.uk

OBJECTIVES

To investigate the electromechanical consequences of nonsurgical septal reduction in a group of patients with hypertrophic obstructive cardiomyopathy (HOCM).

BACKGROUND

Patients with HOCM may benefit symptomatically from nonsurgical septal reduction as an alternative to dual chamber pacing and sensing (DDD) pacing and surgical myectomy.

METHODS

We studied 20 symptomatic patients with HOCM (12 men), mean age 52 ± 17 years, before and after septal reduction using echocardiography and electrocardiogram (ECG).

RESULTS

Septal reduction with a significant rise in cardiac enzymes was successfully achieved in all patients resulting in a 50% reduction in resting left ventricular (LV) outflow tract gradient within 24 h of procedure and an 80% reduction after six months. Left ventricular outflow tract diameter increased at 24 h with a further increase six months later. QRS duration increased by 35 ms at 24 h after procedure associated with right bundle branch block (RBBB) and significant rightward axis rotation in 16 patients. R-wave amplitude in V1 fell by 7 ± 4 mm in 15/20 patients, 13 of whom developed reduction of septal long axis excursion. Left-axis deviation appeared in three patients and septal q-wave was suppressed in 12 long-axis excursion; peak shortening and lengthening rates all fell at the septal site by 20% at 24 h. Only septal excursion returned back to baseline values at six months. Wall motion also became incoordinate so that postejection septal shortening increased by three times control values at 24 h and by four times six months later.

CONCLUSIONS

Nonsurgical septal reduction is associated with a drop in LV outflow tract obstruction and the creation of a localized myocardial infarction (MI) increasing LV outflow tract diameter. The technique also results in a consistent alteration of septal activation and secondary incoordination. The latter could play a significant role in gradient reduction and symptomatic improvement in a manner similar to that seen with DDD pacing.

Abbreviations and Acronyms   ANOVA = analysis of variance   AST = aspartate transferase   CK = creatine phosphokinase   CK-MB = myocardial isoenzyme   DDD = dual chamber pacing and sensing   ECG = electrocardiogram   HOCM = hypertrophic obstructive cardiomyopathy   LBBB = left bundle branch block   LV = left ventricle or ventricular   QTc = QT interval corrected for heart rate   RBBB = right bundle branch block   RV = right ventricle

This article has been cited by other articles:

				B. J. Maron Surgical Myectomy Remains the Primary Treatment Option for Severely Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy Circulation, July 10, 2007; 116(2): 196 - 206. [Full Text] [PDF]

				C. van der Lee, F. J. ten Cate, M. L. Geleijnse, M. J. Kofflard, C. Pedone, L. A. van Herwerden, E. Biagini, W. B. Vletter, and P. W. Serruys Percutaneous Versus Surgical Treatment for Patients With Hypertrophic Obstructive Cardiomyopathy and Enlarged Anterior Mitral Valve Leaflets Circulation, July 26, 2005; 112(4): 482 - 488. [Abstract] [Full Text] [PDF]

				W. G. van Dockum, A. M. Beek, F. J. ten Cate, J. M. ten Berg, O. Bondarenko, M. J.W. Gotte, J. W.R. Twisk, M. B.M. Hofman, C. A. Visser, and A. C. van Rossum Early Onset and Progression of Left Ventricular Remodeling After Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy Circulation, May 17, 2005; 111(19): 2503 - 2508. [Abstract] [Full Text] [PDF]

				M. V. Sherrid, F. A. Chaudhry, and D. G. Swistel Obstructive hypertrophic cardiomyopathy: echocardiography, pathophysiology, and the continuing evolution of surgery for obstruction Ann. Thorac. Surg., February 1, 2003; 75(2): 620 - 632. [Abstract] [Full Text] [PDF]

				S. F. Nagueh, S. J. Stetson, N. M. Lakkis, D. Killip, A. Perez-Verdia, M. L. Entman, W. H. Spencer III, and G. Torre-Amione Decreased Expression of Tumor Necrosis Factor-{{alpha}} and Regression of Hypertrophy After Nonsurgical Septal Reduction Therapy for Patients With Hypertrophic Obstructive Cardiomyopathy Circulation, April 10, 2001; 103(14): 1844 - 1850. [Abstract] [Full Text] [PDF]

				R. Flores-Ramirez, N. M. Lakkis, K. J. Middleton, D. Killip, W. H. Spencer III, and S. F. Nagueh Echocardiographic insights into the mechanisms of relief of left ventricular outflow tract obstruction after nonsurgical septal reduction therapy in patients with hypertrophic obstructive cardiomyopathy J. Am. Coll. Cardiol., January 1, 2001; 37(1): 208 - 214. [Abstract] [Full Text] [PDF]