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Review on sudden death risk reduction after septal reduction therapies in hypertrophic obstructive cardiomyopathy

  • Angelos G. RigopoulosEmail author
  • Muhammad Ali
  • Elena Abate
  • Marios Matiakis
  • Hannes Melnyk
  • Sophie Mavrogeni
  • Dionyssios Leftheriotis
  • Boris Bigalke
  • Michel Noutsias
Article
  • 69 Downloads

Abstract

Treatment of left ventricular outflow tract (LVOT) obstruction in hypertrophic obstructive cardiomyopathy (HOCM) with septal reduction, either with myectomy or alcohol septal ablation, is aiming to reduce the LVOT gradient and improve symptoms in patients who are refractory to or do not tolerate medical treatment. Apart from contributing to the evolution to heart failure, LVOT obstruction is considered a risk factor for sudden cardiac death (SCD). Both septal reduction treatments have been proven effective in reducing symptoms and seem to improve survival, which has been shown equal to the expected in the normal population. SCD is probably reduced after septal reduction, implying that LVOT obstruction is a major factor predisposing to ventricular tachyarrhythmias. Although available algorithms for SCD stratification have not been tested in patients after septal reduction treatments, effective treatment improves SCD risk profile substantially. Furthermore, high-risk patients with already implanted implantable cardioverter defibrillators (ICDs) before septal reduction show very low appropriate ICD shock rate after effective treatment. It should be noted, however, that the best outcomes for septal myectomy or ablation have been reported in HOCM patients treated in high-volume centres, which substantiates the need to refer patients to centres with high procedural expertise.

Keywords

Hypertrophic obstructive cardiomyopathy Outcome Surgical myectomy Treatment Alcohol septal ablation Sudden cardiac death Risk stratification Prognosis 

Abbreviations

ACC

American College of Cardiology

AHA

American Heart Association

ASA

Alcohol septal ablation

CMR

Cardiac magnetic resonance

ESC

European Society of Cardiology

HCM

Hypertrophic cardiomyopathy

HOCM

Hypertrophic obstructive cardiomyopathy

ICD

Implantable cardioverter defibrillator

LGE

Late gadolinium enhancement

LV

Left ventricular

LVOT

Left ventricular outflow tract

SAM

Systolic anterior motion

SCD

Sudden cardiac death

Notes

Compliance with ethical standards

Conflict of interest

AR and MA have received honoraria for presentations from AstraZeneca. MN has received grants by the Deutsche Forschungsgemeinschaft (DFG) through the Sonderforschungsbereich Transregio 19 “Inflammatory Cardiomyopathy” (SFB TR19) (TP B2), and by the University Hospital Giessen and Marburg Foundation Grant “T cell functionality” (UKGM 10/2009). MP has received a grant by the DFG (SFB TR19 TP A2). MN has been consultant to the IKDT (Institute for Cardiac Diagnosis and Therapy GmbH, Berlin) 2004–2008 and has received honoraria for presentations and/or participated in advisory boards from AstraZeneca, Bayer, Boehringer Ingelheim, Fresenius, Miltenyi Biotech, Novartis, Pfizer and Zoll.

Supplementary material

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ESM 1 (DOCX 15.9 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Angelos G. Rigopoulos
    • 1
    Email author
  • Muhammad Ali
    • 1
  • Elena Abate
    • 1
  • Marios Matiakis
    • 1
  • Hannes Melnyk
    • 1
  • Sophie Mavrogeni
    • 2
  • Dionyssios Leftheriotis
    • 3
  • Boris Bigalke
    • 4
  • Michel Noutsias
    • 1
  1. 1.Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical CareUniversity Hospital Halle, Martin-Luther-University Halle-WittenbergHalle (Saale)Germany
  2. 2.Onassis Cardiac Surgery CenterAthensGreece
  3. 3.2nd Department of Cardiology, University of AthensAttikon University HospitalAthensGreece
  4. 4.Department of Cardiology, Charité - Universitätsmedizin BerlinCampus Benjamin FranklinBerlinGermany

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