Alcohol septal ablation: Improving the treatment of obstructive hypertrophic cardiomyopathy

Max Liebregts

    Research output: ThesisThesis fully internal (DIV)

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    Hypertrophic cardiomyopathy (HCM) is the most common inheritable cardiac disease present in 1 in 500 of the general population. HCM is characterized by left ventricular hypertrophy and is often associated with (provocable) left ventricular outflow tract obstruction. First line treatment in patients with significant left ventricular outflow tract obstruction is with negative inotropic drugs (beta-blockers, verapamil, and disopyramide). In the 5-10% of patients who stay highly symptomatic despite optimal medical therapy, septal reduction therapy is indicated, either by surgical myectomy or alcohol septal ablation (ASA). ASA was introduced as a percutaneous alternative to surgical myectomy by Ulrich Sigwart in 1995. Initial performance of ASA was shrouded in safety concerns, due to the intracoronary injection of ethanol, creating a potentially arrhythmogenic ablation scar. In the polarizing debate concerning the role of ASA in the treatment of obstructive HCM, most arguments were based on short-term follow-up studies. In the present thesis we set out to provide long-term results following ASA to 1) decide on its role in the treatment of obstructive HCM, as compared to myectomy; 2) seek ways to improve the outcome of ASA; 3) investigate which patients can benefit from ASA, outside of current expert opinion guidelines; and 4) engage ASA patients in current sudden cardiac death risk prediction models.
    Translated title of the contributionAlcohol septum ablatie: Verbetering van de behandeling van obstructieve hypertrofische cardiomyopathie
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    • van der Harst, Pim, Supervisor
    • ten Berg, Jurrien M., Co-supervisor, External person
    Award date26-Feb-2018
    Place of Publication[Groningen]
    Print ISBNs978-94-034-0377-9
    Electronic ISBNs978-94-034-0376-2
    Publication statusPublished - 2018


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