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DOI: 10.1055/s-0028-1085601
© Georg Thieme Verlag KG Stuttgart · New York
Langzeitverlauf nach perkutaner Septumablation bei hypertropher obstruktiver Kardiomyopathie
Percutaneous septal ablation in hypertrophic obstructive cardiomyopathy: long-term follow-upPublication History
eingereicht: 2.10.2007
akzeptiert: 26.6.2008
Publication Date:
16 September 2008 (online)

Zusammenfassung
Hintergrund und Fragestellung: Bei hypertropher obstruktiver Kardiomyopathie ist eine ausgeprägte Symptomatik trotz optimaler medikamentöser Therapie eine Indikation zur chirurgischen Myotomie/Myektomie bzw. interventionellen Septumablation. Chirurgische Verfahren werden seit mehr als 40 Jahren angewandt. Die Langzeiterfahrungen mit der interventionellen Technik sind sehr begrenzt. Die vorliegende Arbeit stellt die Ergebnisse einer großen Patientenserie vor, die in unserer Klinik durch Septumablation behandelt wurde.
Patienten und Methoden: Bei 347 Patienten (156 weiblich, 191 männlich, 54 ± 15 Jahre) in den klinischen NYHA-Stadien III/IV bzw. II mit objektivierbarer höhergradiger Belastungslimitierung wurde eine perkutane Septumablation (PTSMA) durchgeführt. Mortalität und Morbidität sowie klinische und echokardiografische Variablen wurden bei Nachuntersuchungen in unserer Institution oder durch den zuweisenden Kardiologen ermittelt.
Ergebnisse: Bei einer mittleren Nachbeobachtungszeit von 58 ± 35 Monaten betrug die Gesamtletalität etwa 1,8 % pro Jahr, die kardiovaskuläre Letalität etwa 1 % pro Jahr. Bei 8 % der Patienten war ein Zweiteingriff erforderlich. Die Ablation führte zu einer signifikanten und anhaltenden symptomatischen Besserung (zum Zeitpunkt der letzten Nachbeobachtung befanden sich 89 % der Patienten im NYHA-Stadium I oder II) und Rückbildung der Obstruktion (74 % der Patienten ohne Ruhe-, 60 % zusätzlich ohne provokationsabhängige Obstruktion). Supraventrikuläre Arrhythmien, insbesondere Vorhofflimmern, traten bei 12 % der Patienten auf.
Folgerungen: Die katheterinterventionelle Septumablation bewirkt eine anhaltende Besserung der Symptomatik und der echokardiografischen Parameter ohne eine Risikoerhöhung im Vergleich zu historischen Vergleichskollektiven. Da trotz einer deutlichen klinischen Besserung eine strukturelle Herzerkrankung fortbesteht, sollte bei regelmäßigen Nachsorgeuntersuchungen die Identifikation von Risikopatienten und deren adäquate Behandlung erfolgen.
Summary
Background and objective: Persisting disabling symptoms despite optimal medical treatment in patients with hypertrophic cardiomyopathy and significant outflow tract obstruction prompt surgical or interventional therapy targeted at relief of obstruction. While surgical treatment was introduced more than 40 years ago, there are only a few data on the long-term results of percutaneous septal ablation. This study gives the results of a large number of patients wieth hypertrophic obstructive cardiomyopathy (HOCM) who underwent septal ablation in our institution.
Patients and methods: 347 patients (156 females, 191males, 54 ± 15 years) in NYHA functional class III or IV, or in class II but with evidence of more severe limitation on exercise testing, underwent percutaneous transluminal septal myocardial ablation (PTSMA). Mortality and morbidity, as well as clinical and echocardiographic parameters were assessed during follow-up, either at our institution, or by the referring cardiologist.
Results: During an average follow-up of 58 ± 35 months the overall mortality was about 1,8 % per year, with a cardiovascular-related mortality of about 1 % per year. 8 % of patients needed a second procedure. A significant and sustained improvement of symptoms (89 % patients were in NYHA class I or II a follow-up) and obstruction were demonstrated (74 % of patients were free from obstruction at rest, 60 % did not exhibit provokable gradients). Supraventricular arrhythmias, especially atrial fibrillation, were observed in 12 % of patients.
Conclusion: Percutaneous septal ablation provides significant and sustained beneficial effects on symptoms and echocardiographic variables, without evidence of an excess mortality. But independently of the clinical success of the procedure persistence of the underlying structural heart disease should be kept in mind. Periodic re-evaluation is mandatory to identify and treat high-risk patients.
Schlüsselwörter
hypertrophe obstruktive Kardiomyopathie - perkutane transluminale septale Myokardablation - Risiko-Stratifizierung - DDD-Schrittmacher - ICD
Key words
hypertrophic obstructive cardiomyopathy - percutaneous transluminal septal myocardial ablation - risk stratification - DDD-Pacemaker - ICD
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Priv. Doz. Dr. Lothar Faber
Kardiologische Klinik, Herz- und Diabeteszentrum
NRW, Universitätsklinik der Ruhr-Universität
Bochum
Georgstr. 11
32545 Bad Oeynhausen
Phone: 49 5731 972070
Fax: 49
5731 971874
Email: lfaber@hdz-nrw.de
Email: faber-lothar@t-online.de