Title:A Narrative Review of Emerging Therapies for Hypertrophic Obstructive
Cardiomyopathy
Volume: 19
Issue: 4
Author(s): Antonio da Silva Menezes Junior*, Ana Ligia Valeriano de Oliveira, Thais Aratak Maia and Silvia Marçal Botelho
Affiliation:
- Internal Medicine Department, Medicine School, Federal University of Goiás, Goiânia, Goiás, Brazil
- Medical
School, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
Keywords:
Hypertrophic obstructive cardiomyopathy, therapeutics, alcohol septal ablation, surgical myectomy, radiofrequency septal ablation, comorbidities.
Abstract: Hypertrophic obstructive cardiomyopathy is a hereditary condition that affects myocardial
contraction. In case of failure of pharmacological treatment, alternative approaches might be
used that include surgical myectomy, percutaneous transluminal septal myocardial ablation, and
radiofrequency ablation. In respect of long-term advantages, surgical septal myectomy remains the
therapy of choice for symptomatic hypertrophic obstructive cardiomyopathy. Alcohol septal ablation
has been considered an alternative to surgical myectomy, which confers the benefits of a
shorter hospital stay, less discomfort, and fewer complications. However, only expert operators
should perform it on carefully chosen patients. Further, radiofrequency septal ablation reduces the
left ventricular outflow tract gradient and improves the NYHA functional class of patients with hypertrophic
obstructive cardiomyopathy, despite complications like cardiac tamponade and atrioventricular
block. Further research with a larger sample size is required to compare the radiofrequency
approach with established invasive treatment methods for hypertrophic obstructive cardiomyopathy.
Septal myectomy has low morbidity and mortality rates, making it the preferred procedure;
however, the efficacy and morbidity remain debatable. Advances in invasive techniques, including
percutaneous septal radiofrequency ablation and transcatheter myotomy, have provided alternative
approaches for reducing left ventricular outflow tract (LVOT) obstruction in patients who are not
candidates for traditional surgical septal myectomy. Candidates for alcohol and radiofrequency
septal ablation include patients with symptomatic hypertrophic obstructive cardiomyopathy, older
adults, and those with multiple comorbidities.
