Acute and long-term results after transcoronary ablation of septal hypertrophy (TASH). Catheter interventional treatment for hypertrophic obstructive cardiomyopathy.
OBJECTIVE
To evaluate acute and long-term symptomatic, haemodynamic (at rest and during exercise) and electrophysiological results of transcoronary ablation of septal hypertrophy (TASH), a catheter interventional treatment for hypertrophic obstructive cardiomyopathy.


RESULTS
Sixty-two transcoronary ablations of septal hypertrophy were performed by injection of 4.6+/-2.6 ml 96% ethanol into septal branches in 50 patients with hypertrophic obstructive cardiomyopathy and severe symptoms. Serial left and right heart catheterization, transoesophageal echocardiography and electrophysiological investigations were repeated 2 weeks and 7+/-1 months (n=37) after intervention. Transcoronary ablation of septal hypertrophy led to a reduction in septal thickness, sustained elimination of the outflow obstruction (51+/-41 vs 6+/-10 mmHg at rest, P<0.001; 134+/-48 vs 28+/-32 mmHg, P<0.001, post-extrasystolic), a decrease in left ventricular filling pressures at rest and during exercise and a pronounced clinical improvement. There was no evidence for the creation of an arrhythmogenic substrate as assessed by serial programmed electrical stimulation in 39 patients. However, permanent high-grade atrioventricular block occurred in 17% of the patients. There were two early, but no late deaths during a mean follow-up time of 10. 6+/-5.6 months.


CONCLUSIONS
Transcoronary ablation of septal hypertrophy is a promising new treatment for hypertrophic obstructive cardiomyopathy in patients with severe symptoms. It should now be compared with alternative treatment strategies in prospective randomized studies.
Gietzen
F H
FH
Department of Internal Medicine II - Cardiology Section, Bielefeld Hospital, Academic Teaching Hospital of the University of Münster, Bielefeld, Germany.
Leuner
C J
CJ
Raute-Kreinsen
U
U
Dellmann
A
A
Hegselmann
J
J
Strunk-Mueller
C
C
Kuhn
H J
HJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D002312:Cardiomyopathy, Hypertrophic / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D004594:Electrophysiology; D000431:Ethanol / Q000008:administration & dosage; D015444:Exercise / Q000502:physiology; D005260:Female; D006346:Heart Septum / Q000473:pathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D006984:Hypertrophy; D008297:Male; D008875:Middle Aged; D012597:Sclerosing Solutions / Q000008:administration & dosage; D016896:Treatment Outcome; D016277:Ventricular Function, Left
D012597:Sclerosing Solutions; D000431:Ethanol