Septal ablation techniques for hypertrophic obstructive cardiomyopathy

Summary

Different alternative techniques to alcohol septal ablation (ASA/PTSMA) for hypertrophic obstructive cardiomyopathy have been developed. Most of them target the hypertrophied interventricular septum (IVS) including mechanical (coils embolization or covered stent implantation) or chemical occlusion (different liquid embolic agents) of a septal branch, and endocardial or intramyocardial radiofrequency ablation. Successful gradient reduction can be achieved by all methods. However, known complications of ASA/PTSMA, especially complete heart block requiring implantation of a permanent pacemaker, cannot be avoided by any method. Only limited experience has been reported with the off-label use of percutaneous mitral valve plication by MitraClip implantation. Optimally, indication and choice of the appropriate septal reduction therapy should be discussed within an experienced HCM team.

Introduction

Hypertrophic cardiomyopathy (HCM) is defined of hypertrophy of any region of the left, rarely right, ventricular wall without adequate loading conditions like aortic valve stenosis or long-lasting systemic hypertension. 1 Histologic examinations...