Author + information
- Otto M. Hess, MD and
- Ulrich Sigwart, MD, FRCP⁎ ()
- ↵⁎University Hospital, Centre and Division of Cardiologie, Rue Micheli-du-Crest 24, Geneva CH-1211, Switzerland
We do appreciate Ms. Salberg’s concern regarding the best treatment for patients with hypertrophic obstructive cardiomyopathy. As the representative of the Hypertrophic Cardiomyopathy Association, Ms. Salberg must keep a close eye on what should be recommended to those numerous sufferers from this inherited disease.
Ms. Salberg states that the “counterpoint” we offered in the Journal of the American College of Cardiologyis briefand incomplete(1). The first statement is correct as it was purposely reduced to the minimum in order to make it more readable. The second statement (incomplete) is debatable.
The statement that the investigators have “omitted a treatment strategy from their Figure 1 (pg. 2055) (i.e., septal myectomy), which has, in fact, provided symptomatic benefits and enhanced longevity to thousands of HCM patients worldwide for over 45 years” is, of course, part of the strategy behind the “counterpoint.” We were asked to make the point for the nonsurgical option.
We do believe that alcohol ablation should be the first treatment of choice for patients with hypertrophic obstructive cardiomyopathy who are not well on medical treatment. As Ms. Salberg correctly states, the surgical option has been used for 45 years, although much less over the last 10 years when alcohol ablation became available. According to the published literature, approximately 3,000 patients have been treated surgically over those 45 years. In contrast, more than 4,000 patients have been consigned to the much less invasive strategy of alcohol ablation, which, as most investigators agree, provides similar symptomatic relief. As no randomized trial to compare both treatment options has ever been conducted, it is difficult to justify the significantly higher morbidity and probably also mortality of the surgical technique as a first option.
- American College of Cardiology Foundation