[Transcoronary ablation of septal hypertrophy versus dual-chamber cardiac pacing for the treatment of aged patients with hypertrophic obstructive cardiomyopathy].
OBJECTIVE
To compare the safety and efficacy of transcoronary ablation of septal hypertrophy (TASH) versus dual-chamber cardiac pacing (PM) for the treatment of aged > 60 years old) patients with hypertrophic obstructive cardiomyopathy (HOCM).


METHODS
Medically uncontrolled symptomatic aged patients with hypertrophic obstructive cardiomyopathy (HOCM, n = 23) were treated by transcoronary ablation of septal hypertrophy (TASH, n = 15) or dual-chamber cardiac pacing (PM, n = 8) and followed up for 24 months. Two patients needed permanent pacemaker after TASH were excluded from the analysis.


RESULTS
NYHA class improved from 3.2 +/- 0.7 to 1.5 +/- 0.5 and from 3.0 +/- 0.1 to 1.9 +/- 0.6 and general symptomatic score decreased from 5.9 +/- 1.6 to 1.8 +/- 0.7 and from 4.5 +/- 1.3 to 2.3 +/- 1.6 post TASH or PM treatments, respectively (all P < 0.01 vs. baseline). The decrease of left ventricular outflow pressure gradient (PG) was (80.0 +/- 35.5) mm Hg (1 mmHg = 0.133 kPa) and (49.3 +/- 37.7) mmHg post TASH and PM treatments respectively (all P < 0.05 vs. baseline) and the PG decrease was more significant in TASH group compared to PM group (P < 0.01). Interventricular septal thickness was significantly reduced post TASH [(22 +/- 4) mm vs. (17 +/- 3) mm, P < 0.05] and remained unchanged in PM group. Three patients with paroxysmal atrial fibrillation (2 patients in TASH group and 1 in PM group) developed chronic atrial fibrillation during the follow-up.


CONCLUSIONS
Both therapeutic approaches-TASH and PM implantation, significantly reduced PG and significantly improved NYHA class and general symptomatic score in aged symptomatic patients with HOCM. TASH was superior to PM in terms of PG decrease and general symptomatic score improvement.
Gao
Yue-Chun
YC
Deparment of Cardiology, Anzhen Hospital Affiliated to Capital University of Medical Science, Beijing 100029, China.
Li
Yu
Y
Han
Zhi-Hong
ZH
Zhang
Xiao-Ling
XL
Zhao
Hua
H
Jiang
Teng-Yong
TY
D000368:Aged; D002304:Cardiac Pacing, Artificial; D002312:Cardiomyopathy, Hypertrophic / Q000628:therapy*; D017115:Catheter Ablation; D005500:Follow-Up Studies; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000628:therapy