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(Circulation. 2000;102:600.)
© 2000 American Heart Association, Inc.

Editorial

Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy

The Need for a Registry

William H. Spencer, III, MD; Robert Roberts, MD

From the Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Tex.

Correspondence to Robert Roberts, MD, Section of Cardiology, Baylor College of Medicine, 6550 Fannin, MS SM677, Houston, TX 77030. E-mail rroberts@bcm.tmc.edu

Key Words: Editorials • cardiomyopathy • ablation • genetics

Familial hypertrophic cardiomyopathy is a genetic disease with an autosomal-dominant inheritance.^{1 2 3} Patients with this illness are prone to sudden death, angina, syncope, and heart failure. A subset of patients with familial hypertrophic cardiomyopathy have left ventricular outflow tract obstruction (or hypertrophic obstructive cardiomyopathy [HOCM]) at rest or HOCM that can be induced with the Valsalva maneuver or with dobutamine, isoproterenol infusion, or amyl nitrite inhalation. Patients with significant obstruction have systolic anterior motion of the mitral valve associated with the outflow obstruction, which leads to mitral regurgitation. In association with the hemodynamic burden caused by left ventricular outflow tract obstruction, other abnormalities also contribute to the disabling symptoms. These include impaired left ventricular diastolic and systolic dysfunction, myocardial ischemia, and arrhythmias. In some variant patterns, the level of obstruction may be in the mid-left ventricular cavity rather than subaortic. In addition, midventricular obstruction may be associated with subaortic obstruction. With all these abnormalities of ventricular function, the disease is frequently disabling and progressive.

Numerous treatment options have been suggested for HOCM.^{4 5} The primary aim of medical therapy is relief of left ventricular outflow tract obstruction; this is often done using medications such as ß-blockers, calcium channel blockers (especially verapamil), and disopyramide. Medical therapy benefits many patients and allows them to lead acceptable, productive lives. Frequently, however, high doses of medication produce side effects that resemble the symptoms of HOCM. In the past, cardiac pacing has been suggested as a method of reducing the outflow tract obstruction and improving symptomatology.^{6 7} However, . . . [Full Text of this Article]

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