What are the treatment options for HOCM?

What are the treatment options for HOCM?

Medical therapy of HOCM is based on β-blockers (Table 8.1). Their beneficial effects are likely due to a depression of systolic function and an improvement in diastolic filling and relaxation. However, it is still not clear whether life expectancy is prolonged by this treatment. Amiodarone is a commonly used agent for the control of supraventricular and ventricular dysrhythmias.

Nonmedical treatment options are surgical myotomy/ myomectomy, percutaneous transluminal septal myo-cardial ablation, alcohol septal ablation, mitral valve replacement/valvuloplasty, or a combination of the former. The potential complications of surgical correction of the LVOT obstruction include complete heart block and late formation of a ventricular septal defect due to septal infarction.

Controlled studies did not confirm earlier reports that atrioventricular sequential (DDD) pacing is beneficial for patients with HOCM. Dual-chamber pacing can currently be recommended only in selected patients. The reported annual mortality rate is 1–3%, mostly due to ventricular dysrhythmias, sudden death, progressive heart failure, and atrial fibrillation with embolic stroke. There is accumulat-ing evidence that implantable automated defibrillator devices are highly effective in terminating malignant ventricular dysrhythmias in HOCM patients and, thus, decreasing the incidence of sudden death.