CORRESPONDENCE: LETTER TO THE EDITOR
Reply
A. Selcuk Adabag, MD, MS*,
Barry J. Maron, MD,
Evan Appelbaum, MD,
Caitlin J. Harrigan, BA,
Jacqueline L. Buros, BA,
C. Michael Gibson, MD, MS,
John R. Lesser, MD,
Constance A. Hanna, RN,
James E. Udelson, MD,
Warren J. Manning, MD and
Martin S. Maron, MD
* Veterans Affairs Medical Center, Section of Cardiology (111 C), One Veterans Drive, Minneapolis, Minnesota 55417 (Email: adaba001{at}umn.edu).
We appreciate the interest of Dr. Dhoble and colleagues in our paper (1). Of our reported 177 hypertrophic cardiomyopathy patients, none had undergone alcohol septal ablation before the cardiac magnetic resonance study and 24-h ambulatory Holter electrocardiogram were performed. Nonetheless, Dr. Dhoble and colleagues raise an important point. Percutaneous alcohol septal ablation, pioneered in the last decade as a nonsurgical alternative to surgical myectomy for reduction of left ventricular outflow tract obstruction and heart failure symptoms in hypertrophic cardiomyopathy, intentionally creates a sizable transmural scar in the septum (2). Indeed, there is some evidence that alcohol ablation increases the arrhythmia burden in this disease for which some patients already harbor increased arrhythmogenicity (3). Consequently, alcohol septal ablation is recommended only as a selective alternative to patients for whom the gold standard surgical septal myectomy is undesirable (4).
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References
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- Adabag AS, Maron BJ, Appelbaum E, et al. Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance J Am Coll Cardiol 2008;51:1369-1374.[Abstract/Free Full Text]
- Valeti US, Nishimura RA, Holmes DR, 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 2007;49:350-357.[Abstract/Free Full Text]
- Maron BJ. Controversies in cardiovascular medicine. Surgical myectomy remains the primary treatment option for severely symptomatic patients with obstructive hypertrophic cardiomyopathy. Circulation 2007;116:196-206.[CrossRef][Medline]
- Maron BJ, McKenna WJ, Danielson GK, et al. 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 2003;42:1687-1713.[Free Full Text]
Related Article
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Likelihood of Ventricular Arrhythmias Due to Myocardial Fibrosis in Hypertrophic Cardiomyopathy as Detected by Cardiac Magnetic Resonance Imaging
- Abhijeet Dhoble, Sujeeth R. Punnam, and George S. Abela
J. Am. Coll. Cardiol. 2008 52: 969.
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