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Mariani MV, Pierucci N, Fanisio F, Laviola D, Silvetti G, Piro A, La Fazia VM, Chimenti C, Rebecchi M, Drago F, Miraldi F, Natale A, Vizza CD, Lavalle C. Inherited Arrhythmias in the Pediatric Population: An Updated Overview. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:94. [PMID: 38256355 PMCID: PMC10819657 DOI: 10.3390/medicina60010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
Pediatric cardiomyopathies (CMs) and electrical diseases constitute a heterogeneous spectrum of disorders distinguished by structural and electrical abnormalities in the heart muscle, attributed to a genetic variant. They rank among the main causes of morbidity and mortality in the pediatric population, with an annual incidence of 1.1-1.5 per 100,000 in children under the age of 18. The most common conditions are dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM). Despite great enthusiasm for research in this field, studies in this population are still limited, and the management and treatment often follow adult recommendations, which have significantly more data on treatment benefits. Although adult and pediatric cardiac diseases share similar morphological and clinical manifestations, their outcomes significantly differ. This review summarizes the latest evidence on genetics, clinical characteristics, management, and updated outcomes of primary pediatric CMs and electrical diseases, including DCM, HCM, arrhythmogenic right ventricular cardiomyopathy (ARVC), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT syndrome (LQTS), and short QT syndrome (SQTS).
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Affiliation(s)
- Marco Valerio Mariani
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Nicola Pierucci
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Francesca Fanisio
- Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy; (F.F.); (M.R.)
| | - Domenico Laviola
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Giacomo Silvetti
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Agostino Piro
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Vincenzo Mirco La Fazia
- Department of Electrophysiology, St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX 78705, USA; (V.M.L.F.); (A.N.)
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Marco Rebecchi
- Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy; (F.F.); (M.R.)
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, 00165 Rome, Italy;
| | - Fabio Miraldi
- Cardio Thoracic-Vascular and Organ Transplantation Surgery Department, Policlinico Umberto I Hospital, 00161 Rome, Italy;
| | - Andrea Natale
- Department of Electrophysiology, St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX 78705, USA; (V.M.L.F.); (A.N.)
| | - Carmine Dario Vizza
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
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Jensen MK, Jacobsson L, Almaas V, van Buuren F, Hansen PR, Hansen TF, Aakhus S, Eriksson MJ, Bundgaard H, Faber L. Influence of Septal Thickness on the Clinical Outcome After Alcohol Septal Alation in Hypertrophic Cardiomyopathy. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003214. [PMID: 27217377 DOI: 10.1161/circinterventions.115.003214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 04/14/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND We assessed the influence of interventricular septal thickness (IVSd) on the clinical outcome and survival after alcohol septal ablation (ASA) in patient with hypertrophic cardiomyopathy. METHODS AND RESULTS We analyzed 531 patients with hypertrophic cardiomyopathy (age: 56±14 years, men 55%) treated with ASA. Survival status was obtained 7.9±4.0 years after ASA. Baseline IVSd was inversely associated with survival (hazard ratio [HR] for 1 mm increment, 1.13; confidence interval, 1.05-1.21; P<0.001) after adjustment for age, sex, body mass index, and ASA-performing center. Compared with patients with baseline IVSd <20 mm, patients with baseline IVSd ≥25 mm had reduced survival (HR, 5.0; CI, 2.1-12), whereas patients with baseline IVSd 20 to 24 mm had similar survival (HR, 1.4; CI, 0.7-2.8). Baseline IVSd was not correlated with New York Heart Association class, Canadian Cardiology Society class, or syncope. Clinical outcome was assessed 0.6±0.6 years after ASA. IVSd was not related to left ventricular outflow tract gradient reduction at rest (P=0.883) or during Valsalva maneuver (P=0.885). The proportion of patients in New York Heart Association class 3 to 4 was reduced from 86% to 10%; in Canadian Cardiology Society class 3 to 4 from 26% to 2%; and with syncope from 25% to 2%. There were no correlations between baseline IVSd and New York Heart Association class (P=0.067), Canadian Cardiology Society class (P=0.106), or syncope (P=0.426) after ASA. CONCLUSIONS ASA had equal effects on left ventricular outflow tract gradients and symptoms throughout the spectrum of septal hypertrophy. Severe septal hypertrophy before ASA remained a marker of reduced survival after ASA with a 5-fold increased risk of all-cause mortality in patients with baseline IVSd >25 mm compared with patients with baseline IVSd <20 mm.
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Affiliation(s)
- Morten K Jensen
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.).
| | - Linda Jacobsson
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Vibeke Almaas
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Frank van Buuren
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Peter R Hansen
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Thomas F Hansen
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Svend Aakhus
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Maria J Eriksson
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Henning Bundgaard
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
| | - Lothar Faber
- From the Unit for Inherited Heart Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.K.J., H.B.); Karolinska University Hospital, Stockholm, Sweden (L.J., M.J.E.); Oslo University Hospital, Rikshospitalet, Oslo, Norway (V.A., S.A.); Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (F.v.B., L.F.); and Gentofte Hospital, Hellerup, Denmark (P.R.H., T.F.H.)
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Abstract
Hypertrophic cardiomyopathy is a genetic disorder characterized by marked hypertrophy of the myocardium. It is frequently accompanied by dynamic left ventricular outflow tract obstruction and symptoms of dyspnea, angina, and syncope. The initial therapy for symptomatic patients with obstruction is medical therapy with β-blockers and calcium antagonists. However, there remain a subset of patients who have continued severe symptoms, which are unresponsive to medical therapy. These patients can be treated with septal reduction therapy, either surgical septal myectomy or alcohol septal ablation. When performed by experienced operators working in high-volume centers, septal myectomy is highly effective with a >90% relief of obstruction and improvement in symptoms. The perioperative mortality rate for isolated septal myectomy in most centers is <1%. Alcohol septal ablation is a less invasive treatment. In many patients, the hemodynamic and clinical results are comparable to that of septal myectomy. However, the results of alcohol septal ablation are dependent on the septal perforator artery supplying the area of the contact between the hypertrophied septum and the anterior leaflet of the mitral valve. There are some patients, particularly younger patients with severe hypertrophy, who do not uniformly experience complete relief of obstruction and symptoms. Both techniques of septal reduction therapy are highly operator dependent. The final decision as to which approach should be selected in any given patient is dependent up patient preference and the availability and experience of the operator and institution at which the patient is being treated.
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Affiliation(s)
- Rick A Nishimura
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (R.A.N.); Medizinische Klinik 1, Leopoldina Krankenhaus, Schweinfurt, Germany (H.S.); and Department of Cardiovascular Surgery, Rochester, MN (H.V.S.).
| | - Hubert Seggewiss
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (R.A.N.); Medizinische Klinik 1, Leopoldina Krankenhaus, Schweinfurt, Germany (H.S.); and Department of Cardiovascular Surgery, Rochester, MN (H.V.S.)
| | - Hartzell V Schaff
- From the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (R.A.N.); Medizinische Klinik 1, Leopoldina Krankenhaus, Schweinfurt, Germany (H.S.); and Department of Cardiovascular Surgery, Rochester, MN (H.V.S.)
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Rigopoulos AG, Seggewiss H. Twenty Years of Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy. Curr Cardiol Rev 2016; 12:285-296. [PMID: 25563291 PMCID: PMC5304253 DOI: 10.2174/1573403x11666150107160344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/14/2014] [Accepted: 12/17/2014] [Indexed: 01/28/2023] Open
Abstract
Hypertrophic obstructive cardiomyopathy is the most common genetic cardiac disease and is generally characterised by asymmetric septal hypertrophy and intraventricular obstruction. Patients with severe obstruction and significant symptoms that persist despite optimal medical treatment are candidates for an invasive septal reduction therapy. Twenty years after its introduction, percutaneous transluminal alcohol septal ablation has been increasingly preferred for septal reduction in patients with drug refractory hypertrophic obstructive cardiomyopathy. Myocardial contrast echocardiography and injection of reduced alcohol volumes have increased safety, while efficacy is comparable to the surgical alternative, septal myectomy, which has for decades been regarded as the 'gold standard' treatment. Data on medium- and long-term survival show improved prognosis with survival being similar to the general population. Current guidelines have supported its use by experienced operators in centres specialised in the treatment of patients with hypertrophic obstructive cardiomyopathy.
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Affiliation(s)
- Angelos G Rigopoulos
- Medizinische Klinik 1, Leopoldina Krankenhaus Schweinfurt, Gustav-Adolf-Str. 8, 97422 Schweinfurt, Germany.
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Rigopoulos AG, Daci S, Pfeiffer B, Papadopoulou K, Neugebauer A, Seggewiss H. Low occurrence of ventricular arrhythmias after alcohol septal ablation in high-risk patients with hypertrophic obstructive cardiomyopathy. Clin Res Cardiol 2016; 105:953-961. [PMID: 27270758 DOI: 10.1007/s00392-016-1005-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 05/31/2016] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Percutaneous alcohol septal ablation (PTSMA) is an established treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). However, there is concern of a higher risk for ventricular tachyarrhythmias and sudden death due to the myocardial scar created after PTSMA. We investigated the possibility of increased ventricular arrhythmias and risk of sudden death after PTSMA in a subgroup of patients with an already implanted ICD. METHODS AND RESULTS Between 2009 and 2012, 239 PTSMAs were performed in 212 patients with HOCM. In 32 of those an ICD had already been implanted before PTSMA for primary (31 patients) or secondary (1 patient) prevention of sudden death. The maximum left ventricular outflow tract gradient (LVOTG) was reduced from 114 ± 39 mmHg before PTSMA to 23 ± 19 mmHg (P < 0.0001). Among clinical risk factors for sudden death, nonsustained ventricular tachycardia (VT), syncope and family history for sudden death were most common. After a median follow-up of 5.3 (IQR 4.3-5.7) years after PTSMA only one patient had ICD shocks (annual ICD discharge 0.6 %). In another 3 patients, with already documented nonsustained VTs as risk factor before ICD implantation, VT episodes that activated antitachycardic pacing were recorded. The annual appropriate ICD intervention including all events was 2.5 % and involved only patients with a very high estimated 5-year sudden death risk before PTSMA (>14.3 %). CONCLUSIONS In a selected high-risk patient cohort with HOCM ominous arrhythmic events seem to be rare and predominantly occur in patients with a very high estimated risk of sudden death before PTSMA.
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MESH Headings
- Ablation Techniques/adverse effects
- Adolescent
- Adult
- Aged
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/mortality
- Cardiomyopathy, Hypertrophic/surgery
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electric Countershock/instrumentation
- Ethanol/administration & dosage
- Ethanol/adverse effects
- Female
- Germany
- Humans
- Male
- Middle Aged
- Retrospective Studies
- Risk Factors
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/mortality
- Tachycardia, Ventricular/therapy
- Time Factors
- Treatment Outcome
- Ventricular Outflow Obstruction/diagnosis
- Ventricular Outflow Obstruction/etiology
- Ventricular Outflow Obstruction/mortality
- Ventricular Outflow Obstruction/surgery
- Young Adult
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Affiliation(s)
- Angelos G Rigopoulos
- 1st Department of Internal Medicine, Leopoldina Hospital, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Germany.
| | - Silke Daci
- 1st Department of Internal Medicine, Leopoldina Hospital, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Germany
| | - Barbara Pfeiffer
- 1st Department of Internal Medicine, Leopoldina Hospital, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Germany
| | - Konstadia Papadopoulou
- 1st Department of Internal Medicine, Leopoldina Hospital, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Germany
| | - Anna Neugebauer
- 1st Department of Internal Medicine, Leopoldina Hospital, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Germany
| | - Hubert Seggewiss
- 1st Department of Internal Medicine, Leopoldina Hospital, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Germany
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Faber L. Percutaneous Septal Ablation in Hypertrophic Obstructive Cardiomyopathy: From Experiment to Standard of Care. Adv Med 2014; 2014:464851. [PMID: 26556411 PMCID: PMC4590958 DOI: 10.1155/2014/464851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 03/07/2014] [Indexed: 12/13/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is one of the more common hereditary cardiac conditions. According to presence or absence of outflow obstruction at rest or with provocation, a more common (about 60-70%) obstructive type of the disease (HOCM) has to be distinguished from the less common (30-40%) nonobstructive phenotype (HNCM). Symptoms include exercise limitation due to dyspnea, angina pectoris, palpitations, or dizziness; occasionally syncope or sudden cardiac death occurs. Correct diagnosis and risk stratification with respect to prophylactic ICD implantation are essential in HCM patient management. Drug therapy in symptomatic patients can be characterized as treatment of heart failure with preserved ejection fraction (HFpEF) in HNCM, while symptoms and the obstructive gradient in HOCM can be addressed with beta-blockers, disopyramide, or verapamil. After a short overview on etiology, natural history, and diagnostics in hypertrophic cardiomyopathy, this paper reviews the current treatment options for HOCM with a special focus on percutaneous septal ablation. Literature data and the own series of about 600 cases are discussed, suggesting a largely comparable outcome with respect to procedural mortality, clinical efficacy, and long-term outcome.
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Affiliation(s)
- Lothar Faber
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr University Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
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Jensen MK, Prinz C, Horstkotte D, van Buuren F, Bitter T, Faber L, Bundgaard H. Alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy: low incidence of sudden cardiac death and reduced risk profile. Heart 2013; 99:1012-7. [DOI: 10.1136/heartjnl-2012-303339] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sanborn DMY, Sigwart U, Fifer MA. Patient selection for alcohol septal ablation for hypertrophic obstructive cardiomyopathy: clinical and echocardiographic evaluation. Interv Cardiol 2012. [DOI: 10.2217/ica.12.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kilicgedik A, Karabay CY, Aung SM, Guler A, Kalayci A, Tasar O, Kirma C. A successful percutaneous closure of ventricular septal defect following septal myectomy in patients with hypertrophic obstructive cardiomyopathy. Perfusion 2012; 27:253-5. [DOI: 10.1177/0267659112439597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Postoperative ventricular septal defect (post-op VSD) after septal myectomy in patients with hypertrophic obstructive cardiomyopathy is a rare and unexpected complication. We report a case of successful percutaneous closure of VSD following septal myectomy and mitral valve replacement in a patient with intrinsic mitral valve disease and severe mitral valve regurgitation together with hypertrophic obstructive cardiomyopathy.
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Affiliation(s)
- A Kilicgedik
- Can Yücel Koşuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - CY Karabay
- Can Yücel Koşuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - SM Aung
- Can Yücel Koşuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - A Guler
- Can Yücel Koşuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - A Kalayci
- Can Yücel Koşuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - O Tasar
- Can Yücel Koşuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
| | - C Kirma
- Can Yücel Koşuyolu Heart and Research Hospital, Cardiology Clinic, Istanbul, Turkey
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Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy. Circulation 2011; 124:e783-831. [PMID: 22068434 DOI: 10.1161/cir.0b013e318223e2bd] [Citation(s) in RCA: 505] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Bernard J. Gersh
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see for detailed information
- ACCF/AHA Representative
| | - Barry J. Maron
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see for detailed information
- ACCF/AHA Representative
| | | | - Joseph A. Dearani
- Society of Thoracic Surgeons Representative
- American Association for Thoracic Surgery Representative
| | - Michael A. Fifer
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see for detailed information
- ACCF/AHA Representative
| | - Mark S. Link
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see for detailed information
- Heart Rhythm Society Representative
| | - Srihari S. Naidu
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry and other entities may apply; see for detailed information
- Society for Cardiovascular Angiography and Interventions Representative
| | | | | | - Harry Rakowski
- ACCF/AHA Representative
- American Society of Echocardiography Representative
| | | | | | - James E. Udelson
- Heart Failure Society of America Representative
- American Society of Nuclear Cardiology Representative
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Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW, Jacobs AK, Smith SC, Anderson JL, Albert NM, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Krumholz HM, Kushner FG, Nishimura RA, Ohman EM, Page RL, Stevenson WG, Tarkington LG, Yancy CW. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg 2011; 142:e153-203. [DOI: 10.1016/j.jtcvs.2011.10.020] [Citation(s) in RCA: 223] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 58:e212-60. [PMID: 22075469 DOI: 10.1016/j.jacc.2011.06.011] [Citation(s) in RCA: 823] [Impact Index Per Article: 63.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Abstract
Percutaneous septal ablation has emerged as a less invasive treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). In the past decade, the availability of this sophisticated technique has revived the interest of cardiologists in left ventricular outflow tract obstruction, which led to the recognition that most patients with HCM have the obstructive type. Follow-up studies have already shown the safety and efficacy of the procedure, which offers symptomatic relief in most patients. Long-term survival is comparable to historical reports after surgical myectomy. Complications are rare and can be further reduced with increased experience of the operators, and the theoretical concern for possible ventricular arrhythmogenicity of the myocardial scar has not been documented by the existing data. Although there are still no randomized trials, percutaneous septal ablation is undeniably a viable alternative for patients with HOCM.
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Affiliation(s)
- Angelos G Rigopoulos
- 2nd Department of Cardiology, University of Athens Medical School, Athen, Greece
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Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is the prototypic form of pathological cardiac hypertrophy. HCM is an important cause of sudden cardiac death in the young and a major cause of morbidity in the elderly. DESIGN We discuss the clinical implications of recent advances in the molecular genetics of HCM. RESULTS The current diagnosis of HCM is neither adequately sensitive nor specific. Partial elucidation of the molecular genetic basis of HCM has raised interest in genetic-based diagnosis and management. Over a dozen causal genes have been identified. MYH7 and MYBPC3 mutations account for about 50% of cases. The remaining known causal genes are uncommon and some are rare. Advances in DNA sequencing techniques have made genetic screening practical. The difficulty, particularly in the sporadic cases and in small families, is to discern the causal from the non-causal variants. Overall, the causal mutations alone have limited implications in risk stratification and prognostication, as the clinical phenotype arises from complex and often non-linear interactions between various determinants. CONCLUSIONS The clinical phenotype of 'HCM' results from mutations in sarcomeric proteins and subsequent activation of multiple cellular constituents including signal transducers. We advocate that HCM, despite its current recognition and management as a single disease entity, involves multiple partially independent mechanisms, despite similarity in the ensuing phenotype. To treat HCM effectively, it is necessary to delineate the underlying fundamental mechanisms that govern the pathogenesis of the phenotype and apply these principles to the treatment of each subset of clinically recognized HCM.
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Affiliation(s)
- Ali J Marian
- Center for Cardiovascular Genetics, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center and Texas Heart Institute at St. Luke's Episcopal Hospital, 6770 Bertner Street, Suite C900A, Houston, TX 77030, USA.
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Experimental therapies in hypertrophic cardiomyopathy. J Cardiovasc Transl Res 2009; 2:483-92. [PMID: 20560006 DOI: 10.1007/s12265-009-9132-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 09/16/2009] [Indexed: 12/31/2022]
Abstract
The quintessential clinical diagnostic phenotype of human hypertrophic cardiomyopathy (HCM) is primary cardiac hypertrophy. Cardiac hypertrophy is also a major determinant of mortality and morbidity including the risk of sudden cardiac death (SCD) in patients with HCM. Reversal and attenuation of cardiac hypertrophy and its accompanying fibrosis is expected to improve morbidity as well as decrease the risk of SCD in patients with HCM.The conventionally used pharmacological agents in treatment of patients with HCM have not been shown to reverse or attenuate established cardiac hypertrophy and fibrosis. An effective treatment of HCM has to target the molecular mechanisms that are involved in the pathogenesis of the phenotype. Mechanistic studies suggest that cardiac hypertrophy in HCM is secondary to activation of various hypertrophic signaling molecules and, hence, is potentially reversible. The hypothesis is supported by the results of genetic and pharmacological interventions in animal models. The results have shown potential beneficial effects of angiotensin II receptor blocker losartan, mineralocorticoid receptor blocker spironolactone, 3-hydroxy-3-methyglutaryl-coenzyme A reductase inhibitors simvastatin and atorvastatin, and most recently, N-acetylcysteine (NAC) on reversal or prevention of hypertrophy and fibrosis in HCM. The most promising results have been obtained with NAC, which through multiple thiol-responsive mechanisms completely reversed established cardiac hypertrophy and fibrosis in three independent studies. Pilot studies with losartan and statins in humans have established the feasibility of such studies. The results in animal models have firmly established the reversibility of established cardiac hypertrophy and fibrosis in HCM and have set the stage for advancing the findings in the animal models to human patients with HCM through conducting large-scale efficacy studies.
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Seggewiss H, Rigopoulos A, Welge D, Ziemssen P, Faber L. Long-term follow-up after percutaneous septal ablation in hypertrophic obstructive cardiomyopathy. Clin Res Cardiol 2007; 96:856-63. [PMID: 17891517 DOI: 10.1007/s00392-007-0579-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2006] [Accepted: 04/11/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the longterm follow-up results of percutaneous transluminal septal myocardial ablation (PTSMA) in a large patient cohort. BACKGROUND PTSMA by alcohol injection into septal branches has shown good acute and short-term results in symptomatic patients with hypertrophic obstructive cardiomyopathy. METHODS A total of 100 consecutive symptomatic (NYHA class 2.8 +/- 0.6) patients underwent PTSMA. All patients had clinical and non-invasive follow-up at 3 months, 1 year, and annually up to 8 years. RESULTS One patient died at day 2 after intervention due to fulminant pulmonary embolism following deep venous thrombosis, and eight patients required a permanent DDD-pacemaker due to post-interventional complete heart block. Acute reduction of the left ventricular outflow tract gradient was achieved from 76 +/- 37 to 19 +/- 21 mmHg at rest, from 104 +/- 34 to 43 +/- 31 mmHg during Valsalva maneuver, and from 146 +/- 45 to 59 +/- 42 mmHg post extrasystole (p < 0.0001, each). During follow-up (mean follow-up time: 58 +/- 14 months), three additional patients died (sudden death at 48 months, non-cardiac death at 49 months and stroke-related death at 60 months after the index procedure). All living patients showed clinical improvement to NYHA-class 1.4 +/- 0.6 (after 3 months, n = 99), 1.5 +/- 0.6 (after 1 year, n = 99), and 1.6 +/- 0.7 at final follow-up (n = 96; p < 0.0001, each). Non-invasive follow-up studies documented ongoing outflow tract gradient reduction, decrease of septal and left ventricular posterior wall thickness, and improvement of exercise capacity. CONCLUSIONS PTSMA is an effective treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy. Follow-up showed ongoing hemodynamic and clinical improvement without increased mortality and morbidity.
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Affiliation(s)
- H Seggewiss
- Medizinische Klinik 1, Leopoldina-Krankenhaus, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Germany.
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Faber L, Welge D, Fassbender D, Schmidt HK, Horstkotte D, Seggewiss H. One-year follow-up of percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy in 312 patients: predictors of hemodynamic and clinical response. Clin Res Cardiol 2007; 96:864-73. [PMID: 17891518 DOI: 10.1007/s00392-007-0578-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 04/25/2007] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study was to analyze hemodynamic and clinical outcome in a cohort of 312 patients who were followed up over a period of 12 months after alcohol septal ablation (PTSMA) for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). METHODS AND RESULTS PTSMA was intended in 337 patients with HOCM (mean age: 54+/-15 years), with 312 procedures completed by injection of 2.8+/-1.2 ml of alcohol. In 25 patients (8%) the intervention was aborted, mostly because of contrast echocardiographic findings. In the 312 patients who received alcohol, permanent pacing was necessary in 22 cases (7%); and in-hospital mortality was 1.3% (four patients). During follow-up, contact to six patients (2%) was lost, and three additional patients (1%) died. The 299 patients who either underwent non-invasive reassessment in our institution or transmitted followup data from their local physician formed the study population. Improvement in symptoms was reported by 272 patients (91%). Mean NYHA functional class was reduced from 2.9+/-0.4 to 1.5+/-0.7 (p<0.0001) along with a gradient reduction (echo-Doppler) from 59+/-32 to 8+/-15 mmHg at rest, and from 120+/-42 to 28+/-32 mmHg with provocation (p<0.0001 each). Exercise capacity improved from 94+/-51 to 119+/-40 watts (p=0.001), and peak oxygen consumption from 18+/-4 to 21+/-6 ml/ kg/min (p=0.01). Younger age and higher outflow gradients at baseline and immediately after intervention were associated with a less favorable hemodynamic outcome. The degree of limitation of exercise capacity at baseline was the only predictor of symptomatic improvement. CONCLUSIONS Catheter-based septal ablation is an effective non-surgical technique for reducing symptoms and outflow gradients in HOCM. In contrast to a previous study, in this cohort of 312 patients there was no association between post-interventional enzyme release and hemodynamic success. Younger patients with high baseline gradients, however, tended to have a less favorable hemodynamic outcome with higher residual gradients.
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Affiliation(s)
- L Faber
- Department of Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
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Affiliation(s)
- Michael A Fifer
- Cardiology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114-2696, USA.
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Guo H, Wang P, Xing Y, Peng F, Jiang J, Yang B, You B, Qiu Y, Lee JD. Delayed electrocardiographic changes after percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy. J Electrocardiol 2007; 40:356.e1-6. [DOI: 10.1016/j.jelectrocard.2006.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Accepted: 12/14/2006] [Indexed: 10/23/2022]
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Faber L, Seggewiss H, Gietzen FH, Kuhn H, Boekstegers P, Neuhaus L, Seipel L, Horstkotte D. Catheter-based septal ablation for symptomatic hypertrophic obstructive cardiomyopathy: follow-up results of the TASH-registry of the German Cardiac Society. ZEITSCHRIFT FUR KARDIOLOGIE 2005; 94:516-23. [PMID: 16049653 DOI: 10.1007/s00392-005-0256-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 03/14/2005] [Indexed: 05/03/2023]
Abstract
INTRODUCTION In late 1997, the German Cardiac Society set up a multicenter registry to evaluate the acute and mid-term course of all patients (pts.) treated with septal ablation for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). An analysis of the acute results has already been published. We now report on the mid-term course (3-6 months) of 242 pts. registered through September 1999. RESULTS Follow-up was 92% complete (n=222). During follow-up (mean: 4.9+/-2.3 months), an additional 3 pts. died (in-hospital mortality: 3 pts.). A satisfactory clinical effect was reported by 195 pts. (88%); 27 pts. (12%) remained in NYHA classes III and IV. Overall symptomatic improvement (NYHA class: from 2.8+/-0.7 to 1.7+/-0.7) paralleled the outflow gradient (LVOTG) reduction which was further accentuated as compared with the acute result (Doppler measurement at rest: from 57+/-31 to 25+/-25 mmHg to 20+/-21 mmHg; with provocation: from 107+/-53 to 49+/-40, to 44+/-40 mmHg, p<0.001, resp.). Left atrial (LA) diameter (from 46+/-8 to 44+/-7 mm) and septal thickness (from 20+/-5 to 15+/-5 mm; p<0.001, resp.) were also reduced. Comparing the methods for target vessel selection (i.e., with contrast echo monitoring vs pressurefluoroscopy guidance), at followup clinical improvement and hemodynamic measurements were comparable. CONCLUSION Clinical success can be achieved by septal ablation, both with the echocontrast guided and gradient-fluoroscopy guided method, in 88% of highly symptomatic HOCM pts. At mid-term follow-up, symptoms, left atrial size and septal thickness are reduced, and outflow gradients are further improved as compared to the acute result.
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Affiliation(s)
- L Faber
- Kardiologische Klinik Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany
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Antolinos Pérez MJ, de la Morena Valenzuela G, Gimeno Blanes JR, Cerdán Sánchez MDC, Hurtado Martínez JA, Valdés Chavarri M. Rotura de balón y extravasación de alcohol hacia la arteria descendente anterior durante la ablación septal en paciente con miocardiopatía hipertrófica obstructiva. Rev Esp Cardiol 2005. [DOI: 10.1157/13077240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cheng TO. Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy: How much alcohol should be injected? Catheter Cardiovasc Interv 2005; 65:313-4. [PMID: 15812807 DOI: 10.1002/ccd.20384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Wu WC, Bhavsar JH, Aziz GF, Sadaniantz A. An overview of stress echocardiography in the study of patients with dilated or hypertrophic cardiomyopathy. Echocardiography 2004; 21:467-75. [PMID: 15209731 DOI: 10.1111/j.0742-2822.2004.03083.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Stress echocardiography is a useful noninvasive modality for measuring dynamic outflow gradient and contractility changes in patients with hypertrophic cardiomyopathy (HCM) or dilated cardiomyopathy (DCM). In patients with HCM, stress echocardiography may determine the degree of outflow tract obstruction at rest and with activity, can detect occult systolic dysfunction in symptomatic patients with a normal resting left ventricular ejection fraction, and can also be utilized to monitor the efficacy of treatment. In individuals suffering from DCM, stress echocardiography is an important aid in the evaluation of the etiology, diagnosis, and prognosis of the disease as well as the functional status of the patient during either exercise or simulated stress conditions. Dobutamine stress echocardiography, by providing a measurement of the myocardial reserve, is a useful tool to predict the systolic recovery and clinical outcome of patients with heart failure. The stress-induced change in the wall motion score index can also be used as an accurate alternative to predict the peak oxygen consumption rate and exercise capacity of the same patient population. Finally, stress echocardiography has also been used in the identification of the predilated phase of cardiomyopathy in individuals with high clinical suspicion of the disease.
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Affiliation(s)
- Wen-Chih Wu
- Division of Cardiology, Providence VA Medical Center, and The Miriam Hospital, Brown Medical School, Providence, Rhode Island 02908, USA.
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Cheng TO. In Percutaneous Transluminal Septal Myocardial Ablation for Hypertrophic Obstructive Cardiomyopathy, It Is Not the Speed of Intracoronary Alcohol Injection But the Amount of Alcohol Injected That Determines the Resultant Infarct Size. Circulation 2004; 110:e23; author reply e23. [PMID: 15262858 DOI: 10.1161/01.cir.0000135537.69990.0f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disease characterized by unexplained left ventricular hypertrophy, typically involving the interventricular septum. Hypertrophy may be present in infants, but commonly develops during childhood and adolescence. Management of children with HCM aims to provide symptomatic relief and prevention of sudden death, which is the primary cause of death. Unfortunately, no randomized comparative trials to date have assessed different treatment options in HCM. Medical treatment with negative inotropic agents (beta-adrenoceptor antagonists [beta-blockers], verapamil) is the first therapeutic choice in all symptomatic patients. Beta-blockers also appear to have prognostic merit in children. Surgical myectomy is effective in reducing symptoms in children with left ventricular (LV) obstruction who are unresponsive to medical treatment, although a repeat operation may be needed in a substantial proportion of patients due to relapse of LV obstruction. The recently introduced percutaneous septal ablation can also be regarded as a feasible alternative in this cohort. Technical limitations of both invasive therapeutic options should be carefully considered, preferably in experienced centers. Results of recent randomized trials indicate that dual chamber pacing, once considered a therapeutic option for patients with HCM, should only be used as treatment for conduction abnormalities. Regular clinical risk stratification for sudden death is of vital importance for the prevention of sudden death in young patients. Familial history of sudden death at a young age, LV hypertrophy >3 cm, unexplained syncope, nonsustained ventricular tachycardia in Holter monitoring, and abnormal blood pressure response during exercise are currently considered clinical risk factors for sudden death. Each factor has a low positive predictive accuracy, but patients having two or more of these risk factors are deemed as high risk. Secondary prevention of sudden death in patients successfully resuscitated from cardiac arrest and/or sustained ventricular tachycardia warrants treatment with an implantable cardioverter defibrillator (ICD). Primary prevention of sudden death in patients considered to be at high risk should aim at the management of obvious arrhythmogenic mechanisms (paroxysmal atrial fibrillation, sustained monomorphic ventricular tachycardia, conduction system disease, accessory pathway, myocardial ischemia), and the prevention and/or management of ventricular tachyarrhythmias with amiodarone and/or ICD implantation, respectively. The choice of treatment in children is greatly influenced by technical aspects, such as adverse effects of amiodarone, and ICD implantation difficulties or complications. Amiodarone could also be used as a bridge in children at high risk, until they reach adulthood, possibly achieving a lower risk status, or until their physical growth permits ICD implantation as long-term therapy.
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MESH Headings
- Adrenergic beta-Antagonists/therapeutic use
- Amiodarone/therapeutic use
- Anti-Arrhythmia Agents/therapeutic use
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/mortality
- Calcium Channel Blockers/therapeutic use
- Cardiac Pacing, Artificial
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- Cardiovascular Agents/therapeutic use
- Catheter Ablation
- Child
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Endocarditis/prevention & control
- Humans
- Risk Factors
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Affiliation(s)
- Hubert Seggewiss
- Medizinische Klinik I, Leopoldina Krankenhaus, Schweinfurt, Germany.
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Li ZQ, Cheng TO, Liu L, Jin YZ, Zhang M, Guan RM, Yuan L, Hu J, Zhang WW. Experimental study of relationship between intracoronary alcohol injection and the size of resultant myocardial infarct. Int J Cardiol 2003; 91:93-6. [PMID: 12957734 DOI: 10.1016/s0167-5273(02)00592-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hypertrophic obstructive cardiomyopathy (HOCM) is a complex disease with unique pathophysiologic characteristics and a great diversity of morphologic,functional and clinical features. Percutaneous transluminal septal myocardial ablation (PTSMA) using alcohol injection via a catheter into the septal branch of the left anterior descending coronary artery has been recently introduced as a promising nonsurgical therapy for HOCM. However, the relationship between the volume and velocity of intracoronary injection of absolute alcohol and the size of the resultant myocardial infarct has not been investigated. We therefore studied such a relationship in piglets. OBJECTIVES To investigate the relationship between the volume and velocity of selective intracoronary alcohol injection by means of a catheter and the size of the resultant myocardial infarction. METHODS Twenty piglets were equally divided at random into four groups (n=5 in each) according to the volume and the velocity of intracoronary absolute alcohol injection and the coronary arteries injected. Group I: the volume and velocity of injection of alcohol into the left circumflex coronary artery (LCX) were 0.5 ml and 0.2 ml/s, respectively. Group II: the volume and velocity of injection into LCX were 2.0 ml and 0.2 ml/s, respectively. Group III: the volume and velocity of injection of alcohol into the left anterior descending coronary artery (LAD) were 1.2 ml and 0.06 ml/s, respectively. Group IV: the volume and velocity of injection into the LAD were 1.2 ml and 1.2 ml/s, respectively. The resultant myocardial infarcts were then quantitatively measured 6 h after myocardial ablation. RESULTS The myocardial infarct size for group I was 4.26+/-2.71(%), for group II was 10.12+/-4.55(%), for group III was 5.84+/-1.21(%) and for group IV was 7.11+/-1.63(%). There were significant differences in myocardial infarct size with different volumes of intracoronary absolute alcohol injection (0.02<P<0.05). but there were no apparent differences found in myocardial infarct size with different velocities of intracoronary alcohol injection (0.05<P<0.2). CONCLUSIONS The myocardial infarct size is directly related to the volume of intracoronary absolute alcohol injection during myocardial ablation by a catheter, but has no relation to the injection velocity.
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Affiliation(s)
- Zhan Quan Li
- Liaoning Province Heart Disease Intervention Center, Shenyang, China
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Seggewiss H, Rigopoulos A. Ablación septal en la miocardiopatía hipertrófica: situación actual. Rev Esp Cardiol (Engl Ed) 2003; 56:1153-9. [PMID: 14670265 DOI: 10.1016/s0300-8932(03)77031-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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