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Review of Contemporary Invasive Treatment Approaches and Critical Appraisal of Guidelines on Hypertrophic Obstructive
Steven Lebowitz1, Mariusz Kowalewski2,3,4, Giuseppe Maria Raffa5
1University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Insights
Hypertrophic obstructive cardiomyopathy (HOCM) management requires careful patient selection for invasive treatments like surgical myectomy (SM) and alcohol septal ablation (ASA). This review compares standard and novel HOCM therapies, offering guidance for complex cases.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) presents heterogeneously with poor outcomes if untreated.
- Standard invasive treatments include alcohol septal ablation (ASA) and surgical myectomy (SM).
Purpose of the Study:
- To review standard invasive treatments (ASA, SM) for HOCM.
- To summarize and compare novel HOCM management techniques.
- To analyze current guidelines and suggest tailored treatments for complex HOCM presentations.
Main Methods:
- Comprehensive literature search for evidence on ASA, SM, and other invasive HOCM treatments.
- Inclusion of 103 significant publications after initial screening.
Main Results:
- Analysis of guidelines and patient selection for standard and novel HOCM therapies.
- Comparison of SM, ASA, dual-chamber pacing, and radiofrequency catheter ablation.
- Consideration of complex pathoanatomic presentations and future therapies for HOCM.
Conclusions:
- HOCM necessitates treatment to avoid poor long-term outcomes.
- Effective HOCM treatment strategies exist, with patient selection being paramount.
Background:
Hypertrophic obstructive cardiomyopathy (HOCM) is a heterogeneous disease with different clinical presentations, albeit producing similar dismal long-term outcomes if left untreated. Several approaches are available for the treatment of HOCM; e.g., alcohol septal ablation (ASA) and surgical myectomy (SM). The objectives of the current review were to (1) discuss the place of the standard invasive treatment modalities (ASA and SM) for HOCM; (2) summarize and compare novel techniques for the management of HOCM; (3) analyze current guidelines addressing HOCM management; and (4) offer suggestions for the treatment of complex HOCM presentations.
Methods:
We searched the literature and attempted to gather the most relevant and impactful available evidence on ASA, SM, and other invasive means of treatment of HOCM. The literature search yielded thousands of results, and 103 significant publications were ultimately included.
Results:
We critically analyzed available guidelines and provided context in the setting of patient selection for standard and novel treatment modalities. This review offers the most comprehensive analysis to-date of available invasive treatments for HOCM. These include the standard treatments, SM and ASA, as well as novel treatments such as dual-chamber pacing and radiofrequency catheter ablation. We also account for complex pathoanatomic presentations and current guidelines to offer suggestions for tailored care of patients with HOCM. Finally, we consider promising future therapies for HOCM.
Conclusions:
HOCM is a heterogeneous disease associated with poor outcomes if left untreated. Several strategies for treatment of HOCM are available but patient selection for the procedure is crucial.
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