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A retraction has been published: N Engl J Med 2003;348(10):951.
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Background In patients with hypertrophic cardiomyopathy and obstruction of the left ventricular outflow tract, nonsurgical reduction of the septum is a treatment option when medical therapy has failed. We investigated the long-term effects of nonsurgical reduction of the septum on functional capacity and electrocardiographic and echocardiographic characteristics.
Methods Sixty-four consecutive patients with hypertrophic cardiomyopathy and a mean (±SD) age of 48.5±17.2 years underwent nonsurgical reduction of the septum by injection of ethanol into the septal perforator branch of the left anterior descending coronary artery. These patients were assessed by exercise testing, electrocardiography, and resting and dobutamine (stress-induced) echocardiography after a mean period of 3.0±1.3 years.
Results At follow-up, patients had significant improvements in New York Heart Association class, peak oxygen consumption (from 18.4±5.8 to 30.0±4.4 ml per kilogram of body weight per minute, P<0.001), and left ventricular outflow tract gradients (resting gradient, from 64±36 to 16±15 mm Hg; P<0.001; stress-induced gradient, from 132±34 to 45±19 mm Hg; P<0.001). Procedure-related complications included right bundle-branch block in all patients, complete heart block in 31 patients (48 percent), and significant increases in QRS and corrected QT intervals. Seventeen patients (27 percent) required permanent pacing. R-wave amplitude was significantly decreased (from 32±8 to 17±7 mV, P<0.001). The dimensions of the left ventricular cavity increased, and the interventricular septal thickness was reduced.
Conclusions Nonsurgical septal reduction leads to sustained improvements in both subjective and objective measures of exercise capacity in association with a persistent reduction in resting and stress-induced left ventricular outflow tract gradients. It is also associated with a high incidence of procedure-related complete heart block, however, often requiring permanent pacing.
Source Information
From the National Heart and Lung Institute, Royal Brompton and Harefield Hospital, Imperial College of Science, Technology and Medicine, London (W.S., M.Y., M.H., M.F., A.J.S.C., U.S.); the Kaufman Center for Heart Failure and Transplantation, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland (M.Y.); the London School of Hygiene and Tropical Medicine, London (D.W.); and the University Hospital of the Ruhr–University of Bochum, Bad Oeynhausen, Germany (H.S.).
Drs. Shamim and Yousufuddin contributed equally to this article.
Address reprint requests to Dr. Yousufuddin at the Cleveland Clinic Foundation, Kaufman Center for Heart Failure and Transplantation, Department of Cardiovascular Medicine, F-25, 9500 Euclid Ave., Cleveland, OH 44195, or at yousufm{at}ccf.org.
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