Ameliorating the severity of sleep-disordered breathing concomitant with heart failure status after percutaneous transluminal septal myocardial ablation for drug-refractory hypertrophic obstructive cardiomyopathy

The coexistence of sleep-disordered breathing (SDB) and hypertrophic obstructive cardiomyopathy (HOCM) has widely been recognized; however, the impact of percutaneous transluminal septal myocardial ablation (PTSMA) for HOCM on SDB remains unknown. Herein, we examine cardiorespiratory polygraph parameters in patients with drug-refractory HOCM before and after PTSMA. Forty consecutive drug-refractory HOCM patients, admitted to Keio University Hospital, and who underwent cardiorespiratory polygraphy were retrospectively analyzed. Cardiorespiratory polygraphy was performed before and after PTSMA if patients underwent PTSMA. Patients with an apnea-hypopnea index (AHI) ≥5/h were considered to have SDB. The total number of central sleep apneas, obstructive sleep apneas, and hypopnea events was evaluated. Thirty-two out of 40 patients (80%) with drug-refractory HOCM had SDB. All patients experienced relief of heart failure-associated symptoms after PTSMA. The severity of SDB was found to be correlated with left atrial diameter. The AHI decreased after PTSMA [before 15.4 (range 10.9–23.5)/h vs. after 13.1 (8.3–17.8)/h, P = 0.02]. Especially, the hypopnea index decreased after PTSMA. The average and lowest arterial oxygen saturation also increased after PTSMA (94.2 ± 1.9–95.7 ± 1.6%, P = 0.009; 81.3 ± 5.7–85.8 ± 4.8%, P = 0.012, respectively). In patients with drug-refractory HOCM, PTSMA decreased the AHI and improved arterial oxygen saturation measures. Thus, invasive treatment of the left ventricular obstruction ameliorates the severity of SDB, in addition to improving heart failure status.