Abstract 15122: Long-term Outcome After Septal Myectomy in Patients With Hypertrophic Cardiomyopathy Presenting With Cardiac Arrest
Introduction: Surgical myectomy has been shown to improve symptoms and to promote long-term survival of patients with hypertrophic obstructive cardiomyopathy (HCOM). It’s role in prevention of sudden death is less clear. Therefore, the safety and long-term efficacy of extended surgical myectomy guided by an electrophysiological approach was examined in survivors of aborted sudden death associated with HOCM.
Methods: 12 consecutive patients with HOCM who survived out-of-hospital cardiac arrest were studied. Median age at myectomy was 29,5 years. All patients were investigated through chest X-ray, 12 lead electrocardiogram, color-Doppler echocardiography and left and right heart catheterization. In addition, all patients underwent a complete electrophysiological study including programmed atrial and ventricular stimulation pre- and postoperatively. Four patients underwent preoperative left ventricular endocardial mapping.
Results: During programmed ventricular stimulation rapid monomorphic ventricular tachycardia (cycle length 200-250 ms) was inducible prior to myectomy in all patients. Following myectomy the resting gradient was completely eliminated and no ventricular tachyarrhythmias were inducible. Patients were followed for 22 years (range 17-26) and none of the patients had syncope or sustained ventricular tachyarrhythmias.
Conclusions: In patients with hypertrophic obstructive cardiomyopathy myectomy guided by an electrophysiological approach represents a potentially curative procedure in the management of ventricular tachyarrhythmias associated with obstruction. These findings are supported by an extensive long-term follow-up period.
Author Disclosures: M. Borggrefe: None.
- © 2014 by American Heart Association, Inc.