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Review on sudden death risk reduction after septal reduction therapies in hypertrophic obstructive cardiomyopathy

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Abstract

Treatment of left ventricular outflow tract (LVOT) obstruction in hypertrophic obstructive cardiomyopathy (HOCM) with septal reduction, either with myectomy or alcohol septal ablation, is aiming to reduce the LVOT gradient and improve symptoms in patients who are refractory to or do not tolerate medical treatment. Apart from contributing to the evolution to heart failure, LVOT obstruction is considered a risk factor for sudden cardiac death (SCD). Both septal reduction treatments have been proven effective in reducing symptoms and seem to improve survival, which has been shown equal to the expected in the normal population. SCD is probably reduced after septal reduction, implying that LVOT obstruction is a major factor predisposing to ventricular tachyarrhythmias. Although available algorithms for SCD stratification have not been tested in patients after septal reduction treatments, effective treatment improves SCD risk profile substantially. Furthermore, high-risk patients with already implanted implantable cardioverter defibrillators (ICDs) before septal reduction show very low appropriate ICD shock rate after effective treatment. It should be noted, however, that the best outcomes for septal myectomy or ablation have been reported in HOCM patients treated in high-volume centres, which substantiates the need to refer patients to centres with high procedural expertise.

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Abbreviations

ACC:

American College of Cardiology

AHA:

American Heart Association

ASA:

Alcohol septal ablation

CMR:

Cardiac magnetic resonance

ESC:

European Society of Cardiology

HCM:

Hypertrophic cardiomyopathy

HOCM:

Hypertrophic obstructive cardiomyopathy

ICD:

Implantable cardioverter defibrillator

LGE:

Late gadolinium enhancement

LV:

Left ventricular

LVOT:

Left ventricular outflow tract

SAM:

Systolic anterior motion

SCD :

Sudden cardiac death

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Authors and Affiliations

  1. Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany

    Angelos G. Rigopoulos, Muhammad Ali, Elena Abate, Marios Matiakis, Hannes Melnyk & Michel Noutsias

  2. Onassis Cardiac Surgery Center, 50 Esperou Street, Palaeo Faliro, 17561, Athens, Greece

    Sophie Mavrogeni

  3. 2nd Department of Cardiology, University of Athens, Attikon University Hospital, Rimini St. 1, Haidari, 12462, Athens, Greece

    Dionyssios Leftheriotis

  4. Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany

    Boris Bigalke

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  1. Angelos G. Rigopoulos
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  2. Muhammad Ali
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  3. Elena Abate
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Correspondence to Angelos G. Rigopoulos.

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Conflict of interest

AR and MA have received honoraria for presentations from AstraZeneca. MN has received grants by the Deutsche Forschungsgemeinschaft (DFG) through the Sonderforschungsbereich Transregio 19 “Inflammatory Cardiomyopathy” (SFB TR19) (TP B2), and by the University Hospital Giessen and Marburg Foundation Grant “T cell functionality” (UKGM 10/2009). MP has received a grant by the DFG (SFB TR19 TP A2). MN has been consultant to the IKDT (Institute for Cardiac Diagnosis and Therapy GmbH, Berlin) 2004–2008 and has received honoraria for presentations and/or participated in advisory boards from AstraZeneca, Bayer, Boehringer Ingelheim, Fresenius, Miltenyi Biotech, Novartis, Pfizer and Zoll.

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Rigopoulos, A.G., Ali, M., Abate, E. et al. Review on sudden death risk reduction after septal reduction therapies in hypertrophic obstructive cardiomyopathy. Heart Fail Rev 24, 359–366 (2019). https://doi.org/10.1007/s10741-018-09767-w

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