Published Online
on July 1, 2002

A more recent version of this article appeared on July 23, 2002

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Submitted on March 14, 2002
Revised on May 9, 2002
Accepted on May 9, 2002

Role of Transcoronary Ablation of Septal Hypertrophy in Patients With Hypertrophic Cardiomyopathy, New York Heart Association Functional Class III or IV, and Outflow Obstruction Only Under Provocable Conditions

Frank H. Gietzen MD^*, Christian J. Leuner MD, Ludger Obergassel MD, Claudia Strunk-Mueller MD, and Horst Kuhn MD

From the Department of Internal Medicine and Cardiology, The Bielefeld Hospital, Academic Teaching Hospital of the University of Muenster, Bielefeld, Germany.

^* To whom correspondence should be addressed. E-mail: Gietzen{at}t-online.de.

Background—Transcoronary ablation of septal hypertrophy (TASH) for hypertrophic cardiomyopathy seems to be an effective alternative to surgical myectomy. It remains a point of debate whether an outflow obstruction at rest is a necessary criterion for interventional therapy.

Methods and Results—TASH was compared in 45 consecutive patients with no resting gradient and a provocable gradient of 30 mm Hg (group I) and in 84 consecutive patients with a resting gradient of 30 mm Hg (80±33 mm Hg) (group II). At baseline, all patients were in NYHA functional class (FC) III or IV, unresponsive to medical treatment. Patients in group I were older (63±12 versus 55±17 years, P=0.005) and had a lower postextrasystolic gradient (110±44 versus 171±40 mm Hg, P<0.001). The groups were similar with respect to NYHA FC (3.1±0.3 versus 3.1±0.3), basal septal thickness (22±4 versus 23±3 mm), maximal oxygen consumption (13.1±4.6 versus 14.5±5.0 mL/kg per minute), and pulmonary artery mean pressure at workload (42±9 versus 42±10 mm Hg) (P>0.05). Median follow-up was 7 months after TASH. The 2 groups showed a significant and similar improvement in provocable obstruction (to 24±24 and 56±51 mm Hg, respectively), basal septal thickness (to 12±3 and 12±4 mm, respectively), NYHA FC (to 1.7±0.6 and 1.5±0.6, respectively), maximal oxygen consumption (to 16.0±5.3 and 16.6±6.0 mL/kg per minute, respectively), and pulmonary artery mean pressure at workload (to 36±9 and 34±9 mm Hg, respectively) (P>0.05).

Conclusions—TASH seems to have beneficial clinical and hemodynamic effects in patients with either provocable or resting outflow obstruction.

Key words: cardiomyopathy • hypertrophy • catheter ablation • alcohol • hemodynamics

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