Non-surgical septal myocardial reduction by coil embolization for hypertrophic obstructive cardiomyopathy: early and 6 months follow-up

Aims To evaluate the feasibility and the incidence of complete heart block (CHB) after non-surgical septal myocardial reduction by coil embolization in hypertrophic obstructive cardiomyopathy (HOCM). Methods and results Twenty patients with HOCM and drug-refractory symptoms underwent non-surgical my...

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Bibliographic Details
Published in:European heart journal 2008-02, Vol.29 (3), p.348-355
Main Authors: Durand, Eric, Mousseaux, Elie, Coste, Pierre, Pillière, Rémy, Dubourg, Olivier, Trinquart, Ludovic, Chatellier, Gilles, Hagège, Albert, Desnos, Michel, Lafont, Antoine
Format: Article
Language:English
Subjects:
Aged
Alcohol
Biological and medical sciences
Cardiology. Vascular system
Cardiomyopathy, Hypertrophic - diagnosis
Cardiomyopathy, Hypertrophic - therapy
Catheter Ablation - adverse effects
Catheter Ablation - methods
Cohort Studies
Coil
Complete heart block
Contrast Media
Coronary Vessels
Embolization
Embolization, Therapeutic - adverse effects
Embolization, Therapeutic - instrumentation
Embolization, Therapeutic - methods
Exercise Test
Feasibility Studies
Female
Heart
Heart Block - epidemiology
Heart Septum
Humans
Hypertrophic obstructive cardiomyopathy
Male
Medical sciences
Middle Aged
Myocarditis. Cardiomyopathies
Pilot Projects
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Stents
Treatment Outcome
Citations: Items that cite this one
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Summary:Aims To evaluate the feasibility and the incidence of complete heart block (CHB) after non-surgical septal myocardial reduction by coil embolization in hypertrophic obstructive cardiomyopathy (HOCM). Methods and results Twenty patients with HOCM and drug-refractory symptoms underwent non-surgical myocardial septal reduction by coil embolization with detachable coils. Occlusion of septal perforator branches was successfully performed in all patients. We detected neither ventricular tachycardia nor CHB. One patient presented an interventricular septal defect after the procedure, and died 19 days later. Cardiac magnetic resonance imaging showed, in all patients, an increase in areas of hyperenhancement in the interventricular septum (IVS) compared with baseline. At 6-month follow-up, NYHA functional class and peak oxygen consumption were significantly improved compared with baseline (14.8 ± 4.5 vs. 18.5 ± 4.5 mL/kg/min; P = 0.001, respectively). Echocardiography showed a significant reduction of the IVS thickness and left ventricular outflow tract gradient (21 ± 3 vs. 17 ± 4 mm, P < 0.0001; 80 ± 29 to 35 ± 29 mmHg, P < 0.0001, respectively). Conclusion The results of this pilot non-randomized study suggest that non-surgical septal myocardial reduction by coil embolization in HOCM is feasible and does not induce CHB. Larger studies, ideally with a randomized comparison between coil embolization and alcohol septal ablation, are warranted.
ISSN:0195-668X
1522-9645
DOI:10.1093/eurheartj/ehm632