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Electromechanical left ventricular behavior after nonsurgical septal reduction in patients with hypertrophic obstructive cardiomyopathy.

Abstract：

OBJECTIVES:To investigate the electromechanical consequences of nonsurgical septal reduction in a group of patients with hypertrophic obstructive cardiomyopathy (HOCM). BACKGROUND:Patients with HOCM may benefit symptomatically from nonsurgical septal reduction as an alternative to dual chamber pacing and sensing (DDD) pacing and surgical myectomy. METHODS:We studied 20 symptomatic patients with HOCM (12 men), mean age 52 +/- 17 years, before and after septal reduction using echocardiography and electrocardiogram (ECG). RESULTS:Septal reduction with a significant rise in cardiac enzymes was successfully achieved in all patients resulting in a 50% reduction in resting left ventricular (LV) outflow tract gradient within 24 h of procedure and an 80% reduction after six months. Left ventricular outflow tract diameter increased at 24 h with a further increase six months later. QRS duration increased by 35 ms at 24 h after procedure associated with right bundle branch block (RBBB) and significant rightward axis rotation in 16 patients. R-wave amplitude in V1 fell by 7 +/- 4 mm in 15/20 patients, 13 of whom developed reduction of septal long axis excursion. Left-axis deviation appeared in three patients and septal q-wave was suppressed in 12 long-axis excursion; peak shortening and lengthening rates all fell at the septal site by 20% at 24 h. Only septal excursion returned back to baseline values at six months. Wall motion also became incoordinate so that postejection septal shortening increased by three times control values at 24 h and by four times six months later. CONCLUSIONS:Nonsurgical septal reduction is associated with a drop in LV outflow tract obstruction and the creation of a localized myocardial infarction (MI) increasing LV outflow tract diameter. The technique also results in a consistent alteration of septal activation and secondary incoordination. The latter could play a significant role in gradient reduction and symptomatic improvement in a manner similar to that seen with DDD pacing.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Henein MY,O'Sullivan CA,Ramzy IS,Sigwart U,Gibson DG

doi

10.1016/s0735-1097(99)00332-0

subject

Has Abstract

pub_date

1999-10-01 00:00:00

pages

1117-22

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(99)80014-X

journal_volume

pub_type

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Electromechanical left ventricular behavior after nonsurgical septal reduction in patients with hypertrophic obstructive cardiomyopathy.