CLINICAL RESEARCH: HYPERTROPHIC CARDIOMYOPATHY
Alcohol septal ablation versus surgical septal myectomy
Comparison of effects on atrioventricular conduction tissue
Deepak R. Talreja, MD*,
Rick A. Nishimura, MD ,*,
William D. Edwards, MD ,
Uma S. Valeti, MD*,
Steve R. Ommen, MD,
A. Jamil Tajik, MD,
Joseph A. Dearani, MD ,
Hartzell V. Schaff, MD and
David R. Holmes, Jr, MD
* Mayo Graduate School of Medicine
Cardiovascular Diseases
Anatomic Pathology
Cardiac Surgery, Mayo Foundation, Rochester, Minnesota
Manuscript received May 6, 2004;
revised manuscript received August 5, 2004,
accepted September 6, 2004.
* Reprint requests and correspondence: Dr. Rick A. Nishimura, Mayo Clinic, 200 First Street S.W., Rochester, Minnesota 55905 (Email: nishimura.rick{at}mayo.edu).
OBJECTIVES: This study was designed to evaluate the effect of septal reduction therapies on the conduction system for patients with hypertrophic cardiomyopathy (HCM).
BACKGROUND: Heart block is a potential complication of both catheter-based and surgical procedures to relieve left ventricular outflow tract obstruction in HCM, but it is important to understand the different effects of these treatments on the conduction system.
METHODS: The electrocardiograms and postoperative course of patients who underwent percutaneous alcohol septal ablation or surgical myectomy at Mayo Clinic between 1999 and 2003 were reviewed.
RESULTS: For the 58 patients who underwent alcohol septal ablation, 21 (36%) developed right bundle branch block. Six patients (12%) developed complete heart block requiring permanent pacing, three of whom had left bundle branch block before the procedure. Among the 117 patients who underwent surgical septal myectomy, 47 (40%) developed left bundle branch block. Four patients (3%) developed heart block requiring permanent pacing after the procedure, three of whom had right bundle branch block preoperatively.
CONCLUSIONS: Percutaneous septal ablation selectively produces transmural infarction of the basal mid-septum and adjacent right bundle tissue, whereas surgical myectomy affects the endocardial portion of the basal anterior septum and adjacent left bundle tissue. These observations may help identify patients at risk for complete heart block after septal reduction procedures for HCM.
|
Abbreviations and Acronyms
| | CHB = complete heart block | | HCM = hypertrophic cardiomyopathy | | LBBB = left bundle branch block | | LVOT = left ventricular outflow tract | | PPM = permanent pacemaker | | RBBB = right bundle branch block |
|
This article has been cited by other articles:
|
|
|
|
 
T. Carrel and J. Schmidli
Septal myectomy for hypertrophic obstructive cardiomyopathy: coil, boil and the role of rescue surgery
Eur. J. Cardiothorac. Surg.,
July 1, 2009;
36(1):
210 - 211.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W A Jaber, E H Yang, R A Nishimura, P Sorajja, C S Rihal, A Elesber, E Eeckhout, and A Lerman
Immediate improvement in coronary flow reserve after alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy
Heart,
April 1, 2009;
95(7):
564 - 569.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Sorajja, U. Valeti, R. A. Nishimura, S. R. Ommen, C. S. Rihal, B. J. Gersh, D. O. Hodge, H. V. Schaff, and D. R. Holmes Jr
Outcome of Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy
Circulation,
July 8, 2008;
118(2):
131 - 139.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Togni, M. Billinger, S. Cook, and O. M. Hess
Septal myectomy: cut, coil, or boil?
Eur. Heart J.,
February 1, 2008;
29(3):
296 - 298.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Durand, E. Mousseaux, P. Coste, R. Pilliere, O. Dubourg, L. Trinquart, G. Chatellier, A. Hagege, M. Desnos, and A. Lafont
Non-surgical septal myocardial reduction by coil embolization for hypertrophic obstructive cardiomyopathy: early and 6 months follow-up
Eur. Heart J.,
February 1, 2008;
29(3):
348 - 355.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. W. ElBardissi, J. A. Dearani, R. A. Nishimura, S. R. Ommen, J. M. Stulak, and H. V. Schaff
Septal Myectomy After Previous Septal Artery Ablation in Hypertrophic Cardiomyopathy
Mayo Clin. Proc.,
December 1, 2007;
82(12):
1516 - 1522.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Williams and M. Frenneaux
Syncope in hypertrophic cardiomyopathy: mechanisms and consequences for treatment
Europace,
September 1, 2007;
9(9):
817 - 822.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Fifer
Most Fully Informed Patients Choose Septal Ablation Over Septal Myectomy
Circulation,
July 10, 2007;
116(2):
207 - 216.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. W. Heldman, K. C. Wu, T. P. Abraham, and D. E. Cameron
Myectomy or Alcohol Septal Ablation: Surgery and Percutaneous Intervention Go Another Round
J. Am. Coll. Cardiol.,
January 23, 2007;
49(3):
358 - 360.
[Full Text]
[PDF]
|
|
|
|
|
|
|
U. S. Valeti, R. A. Nishimura, D. R. Holmes, P. A. Araoz, J. F. Glockner, J. F. Breen, S. R. Ommen, B. J. Gersh, A. J. Tajik, C. S. Rihal, et al.
Comparison of Surgical Septal Myectomy and Alcohol Septal Ablation With Cardiac Magnetic Resonance Imaging in Patients With Hypertrophic Obstructive Cardiomyopathy
J. Am. Coll. Cardiol.,
January 23, 2007;
49(3):
350 - 357.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J Knight
Alcohol septal ablation for obstructive hypertrophic cardiomyopathy.
Heart,
September 1, 2006;
92(9):
1339 - 1344.
[Full Text]
[PDF]
|
|
|
|
