EP Lab Digest - May 2008 - (Page 30)

EP APPROACH Mutations in the genes for cardiac troponin T and alpha-tropomyosin in hypertrophic cardiomyopathy. N Engl J Med 1995;332:10581064. Valeti US, Nishimura RA, Holmes DR, et al. Comparison of surgical septal myectomy and alcohol septal ablation with cardiac magnetic resonance imaging in patients with hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 2007;49:350-357. Elliott PM, Gimeno Blanes JR, Mahon NG, et al. Relation between severity of left-ventricular hypertrophy and prognosis in patients with hypertrophic cardiomyopathy. Lancet 2001;357:420-424. Spirito P, Bellone P, Harris KM, et al. Magnitude of left ventricular hypertrophy predicts the risk of sudden death in hypertrophic cardiomyopathy. N Engl J Med 2000;342:1778-1785. Elliott PM, Poloniecki J, Dickie S, et al. Sudden death in hypertrophic cardiomyopathy: Identification of high risk patients. J Am Coll Cardiol 2000;36:2212-2218. Maron BJ. Hypertrophic cardiomyopathy. Lancet 1997;350:127-133. David A. Cesario DA, Dec GW. Implantable cardioverter-defibrillator therapy in clinical practice. J Am Coll Cardiol 2006;47:15071517. Marian AJ, Roberts R. Recent advances in the molecular genetics of hypertrophic cardiomyopathy. Circulation 1995;92:1336-1347. Spirito P, Seidman CE, McKenna WJ, Maron BJ. Management of hypertrophic cardiomyopathy. N Engl J Med 1997;336:775-785. Maron BJ, Gross BW, Stark SI. Images in cardiovascular medicine. Extreme left ventricular hypertrophy. Circulation 1995;92:2748. Alam M, Dokainish H, Lakkis N. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: A systematic review of published studies. J Interv Cardiol 2006;19:319–327. Faber L, Ziemssen P, Seggewiss H. Targeting percutaneous transluminal septal ablation for hypertrophic obstructive cardiomyopathy by intraprocedural echocardiographic monitoring. J Am Soc Echocardiogr 2000;13:1074-1079. Lawrenz T, Lieder F, Bartelsmeier M, et al. Predictors of complete heart block after transcoronary ablation of septal hypertrophy: Results of a prospective electrophysiological investigation in 172 patients with hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 2007;49:2356-2363. Chang SM, Nagueh SF, Spencer WH 3rd, Lakkis NM. Complete heart block: determinants and clinical impact in patients with hypertrophic obstructive cardiomyopathy undergoing nonsurgical septal reduction therapy. J Am Coll Cardiol 2003;42:296-300. Streit S,Walpoth N,Windecker S, et al. Is alcohol ablation of the septum associated with recurrent tachyarrhytmias? Swiss Med Wkly 2007;137:660-668. Lawrenz T, Obergassel L, Lieder F, et al. Transcoronary ablation of septal hypertrophy does not alter ICD intervention rates in high risk patients with hypertrophic obstructive cardiomyopathy. Pacing Clin Electrophysiol 2005;28:295-300. Nishimura RA, Holmes DR Jr. Clinical practice. Hypertrophic obstructive cardiomyopathy. N Engl J Med 2004;350:1320-1327. McCully RB, Nishimura RA, Tajik AJ, et al. Extent of clinical improvement after surgical treatment of hypertrophic obstructive cardiomyopathy. Circulation 1996;94:467-471. Lakkis NM, Nagueh SF, Dunn JK, et al. Nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy: one-year follow-up. J Am Coll Cardiol 2000;36:852-855. Kern MJ, Holmes DG, Simpson C, et al. Delayed occurrence of complete heart block without warning after alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Catheter Cardiovasc Interv 2002;56:503-507. Faber L, Seggewiss H, Welge D, et al. [Predicting the risk of atrioventricular conduction lesions after percutaneous septal ablation for obstructive hypertrophic cardiomyopathy]. Z Kardiol 2003;92:39-47. Talreja DR, Nishimura RA, Edwards WD, et al. Alcohol septal ablation versus surgical septal myectomy: Comparison of effects on MAY ALCOHOL SEPTAL ABLATION Continued from page 28 11. Given the inherent risk of sudden death in patients with HCM and a somewhat higher risk in patients with significant LVOT obstruction and large septal mass,5,12-15 there is some concern that alcohol ablation may create a scar in the septum that may be a future nidus for re-entry ventricular tachycardia. However, the limited data available to date has failed to find an increased risk of sudden death or ventricular tachycardia in such patients. Confounding the situation is the background level of sudden death in such patients, whether or not an ablative procedure was performed, making a causal relationship difficult to prove. In one series of EP studies after successful alcohol septal ablation, an increased rate of inducible VT was not found. 24,25 Given the significant benefits of alcohol septal ablation in LVH regression, alleviation of LV outflow obstruction, SAM and mitral regurgitation, resultant improvement in quality of life, and the less invasive nature with the avoidance of cardio-pulmonary bypass, it is likely that alcohol septal ablation procedures will continue to be a valid alternative to surgery in select patients. Whether a similar intracoronary ablative procedure may find its way into the EP lab, as a form of therapy for arrhythmic substrates unapproachable by conventional mapping techniques, remains to be seen. 12. 13. 14. 15. 16. 17. 18. Given the significant benefits of alcohol septal ablation in LVH regression, alleviation of LV outflow obstruction, SAM and mitral regurgitation, resultant improvement in quality of life, and the less invasive nature with the avoidance of cardio-pulmonary bypass, it is likely that alcohol septal ablation procedures will continue to be a valid alternative to surgery in select patients. 19. 20. Ablation of Another Sort by Todd J. Cohen, MD 21. 22. 23. 1. Maron BJ. Hypertrophic cardiomyopathy: A systematic review. JAMA 2002;287:13081320. 2. Maron BJ, Gardin JM, Flack JM, et al. Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Circulation 1995;92:785-789. 3. Seidman JG, Seidman C.The genetic basis for cardiomyopathy: From mutation identification to mechanistic paradigms. Cell 2001;104:557–567. 4. Komajda M, Charron P, Tesson F. Genetic aspects of heart failure. Eur J Heart Fail 1999;1:121–126. 5. Wigle ED, Sasson Z, Henderson MA, et al. Hypertrophic cardiomyopathy. The importance of the site and the extent of hypertrophy. A review. Prog Cardiovasc Dis 1985;28:183. 6. Maron BJ, Bonow RO, Cannon RO III, et al. Hypertrophic cardiomyopathy. Interrelations of clinical manifestations, pathophysiology, and therapy. N Engl J Med 1987;316:780-789. 7. Louie EK, Edwards LC III. Hypertrophic cardiomyopathy. Prog Cardiovasc Dis 1994;36:275-308. 8. Wigle ED, Rakowski H, Kimball BP, Williams WG. Hypertrophic cardiomyopathy. Clinical spectrum and treatment. Circulation 1995;92:1680-1692. 9. Watkins H, Rosenzweig A, Hwang DS, et al. Characteristics and prognostic implications of myosin missense mutations in familial hypertrophic cardiomyopathy. N Engl J Med 1992;326:1108-1114. 10. Watkins H, McKenna WJ, Thierfelder L, et al. References 24. 25. 26. 27. 28. 29. As electrophysiologists, we believe we rule the world on ablation — catheter ablation, that is! However, interventionalists such as Dr. Naidu can perform ablations of “another sort.” Any time a doctor destroys, fulgurates, infarcts, and/or kills tissue, they are performing an ablation. In Dr. Naidu’s case report of a patient with hypertrophic cardiomyopathy, ethanol is utilized to infarct the ventricular septum and improve the patient's outflow tract gradient. This approach has some similarities to the percutaneous ablative approach that we electrophysiologists now use routinely for treating arrhythmias. Both ventricular arrhythmias and severe ventricular septal hypertrophy were treated by surgical resection. Percutaneous approaches by both the electrophysiologists and the interventionalists have been refined and are now useful “ablative procedures” in treating arrhythmias and hypertrophic cardiomyopathy, respectively. I hope the readers appreciate this “ablation of another sort” appearing in EP Lab Digest. 30. 31. atrioventricular conduction tissue. J Am Coll Cardiol 2004;44:2329-2332. 32. Maron BJ, McKenna WJ, Danielson GK, et al. American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. J Am Coll Cardiol 2003;42:1687–713. 33. Maron MS, Olivotto I, Zenovich AG, et al. Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction. Circulation 2006;114:2232–2239.

Table of Contents Feed for the Digital Edition of EP Lab Digest - May 2008

EP Lab Digest - May 2008 Is There an Under-Referral of Women for Atrial Fibrillation Ablation? A Hybrid Approach to the Cure of Atrial Fibrillation Contents Letter from the Editor Spotlight Interview: University of Michigan Health System 10-Minute Interview: Amit J. Shanker, MD Modular EP Units: Are They Possible? One Hospital’s Experience All About My Job: Technician Supervisor (New Column!) Alcohol Septal Ablation in the Cath Lab: What is it All About? About the Canadian Heart Rhythm Society: Interview with Martin J. Gardner, MD, FRCP(C), FACC Email Discussion Group: May 2008 Second Annual Salary Survey My First Year in Electrophysiology: What Have I Got Myself Into? Highlight on Technology: Video-Audio Integration for the EP Lab On the Horizon: A New Remote Catheter Manipulation System Striving for Excellence in the Care of Cardiac Patients Five Reasons to Participate with a Professional Organization Suspected Shunting of Defibrillation Energy in the EP Lab Can Digital Music Players Cause Interference with Implantable Devices? ECG 101: Ambulatory ECG Monitoring Events Calendar Industry News and Products Classifieds Advertisers Index

EP Lab Digest - May 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.