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(Circulation. 1998;97:2096-2097.)
© 1998 American Heart Association, Inc.

Correspondence

Alcohol Therapy for Hypertrophic Cardiomyopathy: Is It Time to Toast?

Balram Bhargava, MD, DM; Rajiv Agarwal, MD, DM; Vinay K. Behl, MD, DM; K. Srinath Reddy, MD, DM; Upendra Kaul, MD, DM, FACC; ; Subhash C. Manchanda, MD, DM

Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India

To the Editor:

We have read with interest the article by Knight et al¹ on the new technique of nonsurgical reduction as a therapeutic strategy in patients with hypertrophic obstructive cardiomyopathy (HOCM). We congratulate the authors for obtaining excellent results in their series of 18 patients.

We have used the same technique at our center since early last year in a limited number of patients with excellent immediate reductions in left ventricular outflow tract (LVOT) gradients.^{2 3} However, we briefly discuss the course of our patients, highlighting the complications encountered.

Acute results: The authors, in their series of 18 patients, experienced the complication of transient complete heart block in only 4 patients, while a further 5 patients were on a permanent pacemaker before the septal ablation. However, both our patients developed complete heart block requiring implantation of a permanent dual-chamber pacemaker.

Furthermore, the authors did not develop any adverse results concerning the left ventricular performance of any of their patients. However, one of our patients developed recurrent episodes of pulmonary edema that stabilized only after initiation of the dual-chamber pacemaker and that may be related to stunned myocardium.²

Chronic results: Both our patients have completed more than 3 months of follow-up. The first patient has completed over 1 year. They have both been doing very well and remain asymptomatic, and their reductions in LVOT gradients have been maintained long term.

This elegant procedure of alcohol-induced septal infarction can be successfully used to reduce LVOT gradients in patients with HOCM. However, the . . . [Full Text of this Article]

Ulrich Sigwart, MD, FRCP, FACC, FESC

Director, Department of Invasive Cardiology, Royal Brompton Hospital, Imperial College of Medicine, London, England