How symptomatic should a hypertrophic obstructive cardiomyopathy patient be to consider alcohol septal ablation?

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Abstract

H ypertrophic cardiomyopathy (HCM) is a complex and heterogeneous disease with different anatomical variants, physiologic manifestations, and genetic underpin-nings. Even asymptomatic patients with HCM are at potential risk for sudden cardiac death and require risk stratification and consideration of an implantable car-dioverter-defibrillator for primary or secondary prophylaxis. However, the progression to symptomatic heart failure depends most often on upper septal hypertrophy with systolic anterior motion of the anterior mitral valve leaflet causing left ventricular outflow tract (LVOT) obstruction, elevated gradients, mitral regurgitation, and often atrial fibrillation. Symptoms in patients with LVOT obstruction usually manifest as exertional dyspnea or chest pain, and b-blockers or calcium channel blockers are the mainstay of medical therapy to reduce LV contractile forces and associated LVOT gradients. When symptoms are refractory to medical management, surgical myectomy or alcohol septal ablation (ASA) is considered, and both have been shown to be effective in carefully selected patients.

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Jones, B. M., Krishnaswamy, A., Smedira, N. G., Desai, M. Y., Murat Tuzcu, E., & Kapadia, S. R. (2017, May 1). How symptomatic should a hypertrophic obstructive cardiomyopathy patient be to consider alcohol septal ablation? Journal of the American Heart Association, 6(5). https://doi.org/10.1161/JAHA.117.006292

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