The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on non-surgical reduction of myocardial septum.
This procedure is used to treat hypertrophic obstructive cardiomyopathy.
People with hypertrophic obstructive cardiomyopathy (HOCM) have abnormally thickened heart muscle. Thickening is usually most severe in the wall (septum) between the right and left ventricles and may cause obstruction to the flow of blood out of the left ventricle.
HOCM may cause chest pain, breathlessness, palpitations and syncope. People with HOCM have an increased risk of sudden death from heart attacks or abnormal heart rhythms.
Most people with HOCM are treated with medication. More invasive treatments may be considered in people who still get symptoms despite drug treatment.
The standard surgical treatment is ventricular septal myotomy-myectomy. This is an open surgical technique that requires cardiopulmonary bypass. A small amount of muscle is removed from the septum to reduce its thickness and reduce obstruction.
Non-surgical ablation of the septum does not require open heart surgery or cardiopulmonary bypass. It involves inserting a catheter into the femoral artery and passing it up into the heart under X-ray control. Alcohol is injected into an artery supplying blood to the septum. This destroys a part of the septal muscle which then becomes thinner.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.