Medication, surgical myectomy, alcohol septal ablation. See guidelines at www.escardio.org.
Septal ablation by transcatheter myocardial laser coagulation of the hypertrophic area of the septum. Even frothe RV side. The laser catheter needed for this procedure will recieve CE approval in a few months.
For details see: "Laser based approach to cardiac mapping and ablation" in: LASERS IN CARDIOVASCULAR INTERVENTIONS. On Topaz; Editor. Chapter 17 pp 221-244.
The guidelines are already mentioned. In daily practice, the decision for one of the mentioned therapeutic options should be based on age, concommitant risk factors, location and extent of the muscular hypertrophy - its not always basal septum - and propably presence of a SAM. In younger patients, I would recommend a surgical approach, which can well be performed minimally invasive. In case of doubt, the mitral valve should also be considered for correction.
The laser ablation has already been performed quite sucessfully be Jeff Isner in the late 80ies and I would be very interested in Helmut Weber´s system.
As to my knowledge, there are very few data about the course of preexisting Vt´s/VFib after successful interventional or surgical therapy.
Helmut, if You read this, may be You can get in touch with me to exchange some more information about the laser. Appreciate it.
The majority pts. with HCMP need not ICD, there are thre indcations:
1. positive finding two of 11 gene: alfa tropomiosin and haevi chain of beta myosin. The other is not malignant according VF
2. Positiva sudden death in family or sincopal crisis in pts.
3. possible positive elektrophysiologic provokation.
All other pats. need not ICD. SDome of them nedd op (subaortic stenosis) or bet-blockers only.
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