Hypertrophic cardiomyopathy surgery

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Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1], Cafer Zorkun, M.D. [2], Caitlin J. Harrigan [3], Martin S. Maron, M.D., and Barry J. Maron, M.D. Soroush Seifirad, M.D.[4]

Overview

The surgical management of hypertrophic cardiomyopathy (HCM) encompasses extended septal myectomy (ESM) for obstructive HCM, apical myectomy for nonobstructive apical HCM, concomitant surgical atrial fibrillation (AF) ablation during myectomy, and advanced heart failure surgery (left ventricular assist devices [LVAD] and cardiac transplantation). ESM remains the most broadly applicable septal reduction therapy (SRT) and is the preferred surgical approach when concomitant cardiac pathology requires correction.[1]

Extended Septal Myectomy

Technique

Transaortic extended septal myectomy is performed via median sternotomy under cardiopulmonary bypass. The modern extended technique involves the resection of the hypertrophied basal and mid-septal myocardium through the aortic valve. This extends the resection beyond the classic Morrow procedure to address the deeper septal bulge that redirects flow posteriorly and perpetuates systolic anterior motion (SAM) of the mitral valve. In specialized centers, the procedure may include mobilization and partial excision of anomalous papillary muscles, anterior mitral leaflet plication, or revision of the subvalvular apparatus when anatomically indicated. In infants and young children with a small aortic annulus, a modified Konno procedure or transapical approach (or combined transaortic and transapical) may be used for basal or midventricular obstruction, respectively.[1][2]

Indications

The 2024 AHA/ACC Guideline specifies three general eligibility criteria for SRT: clinical symptoms (typically NYHA class III–IV), hemodynamic evidence of obstruction (LVOT gradient ≥50 mm Hg at rest or with provocation), and anatomic suitability (sufficient septal thickness).

ESM is recommended (Class I) for patients with obstructive HCM who remain symptomatic despite guideline-directed medical therapy (GDMT).[1] It is also a Class I recommendation when concomitant cardiac pathology requires surgical correction, such as anomalous papillary muscles, a markedly elongated anterior mitral leaflet, intrinsic mitral valve disease, multivessel coronary artery disease (CAD), or valvular aortic stenosis.

Earlier myectomy (NYHA class II) may be reasonable (Class IIb) in comprehensive HCM centers for patients with severe or progressive pulmonary hypertension attributable to left ventricular outflow tract obstruction (LVOTO) or mitral regurgitation (MR), left atrial enlargement with symptomatic AF, poor functional capacity on exercise testing, or children/young adults with very high resting LVOT gradients (>100 mm Hg).

The 2024 AHA/ACC Guideline also introduced cardiac myosin inhibitors (mavacamten, aficamten) as a Class I recommendation for symptomatic obstructive HCM patients who remain symptomatic on first-line beta-blockers or non-dihydropyridine calcium channel blockers, prior to consideration of SRT. Both mavacamten (FDA-approved 2022) and aficamten (FDA-approved December 2025) are available for clinical use.[1]

SRT is contraindicated (Class III: Harm) for asymptomatic patients with normal exercise capacity.[1]

Outcomes and Volume-Outcome Relationship

At experienced comprehensive HCM centers, operative mortality for ESM is <1% with clinical success rates exceeding 90–95%.[1][2][3] Successful ESM eliminates or significantly reduces SAM-mediated mitral regurgitation, reduces left atrial size, and induces a small degree of LV reverse remodeling. Surgical myectomy improves heart failure symptoms and quality of life by ≥1 NYHA functional class in ≥90% of patients, with restoration to normal activity in approximately 75%. Objective improvements include increased exercise duration and peak VO2 (by 3–7 mL/kg/min).[3]

Long-term survival following myectomy at experienced centers is similar to that of an age-matched general population. Rates of survival from all-cause mortality are approximately 98%, 96%, and 83% at 1, 5, and 10 years, respectively, while HCM-related survival rates are 99%, 98%, and 95%. The rate of sudden cardiac death (SCD) or appropriate ICD discharge after myectomy is very low (<0.9%).[3][4]

The volume-outcome relationship is critical: surgery-related mortality is ~0.5% at high-volume centers, compared to ≥6% at community hospitals with less-experienced surgeons, where technically inadequate resections are more common.[3]

Comparison with Alcohol Septal Ablation

While no randomized controlled trials exist comparing ESM with alcohol septal ablation (ASA), observational data suggest a long-term survival advantage for myectomy. Five-year survival is similar, but 10-year all-cause mortality is significantly higher following ASA.[1] In a large multicenter study (3,859 patients), 10-year all-cause mortality was 26.1% for ASA versus 8.2% for myectomy (adjusted HR 1.68; P < 0.001).[4] A 2023 meta-analysis of 27 observational studies (15,968 patients) demonstrated similar overall all-cause mortality but higher long-term mortality for ASA in studies with ≥5 years of follow-up (HR 1.50), along with less LVOT gradient reduction and a 9-fold higher reoperation rate with ASA.[5] While ASA has a procedural mortality rate of <1% at experienced centers, it is associated with a higher risk of requiring a permanent pacemaker compared to myectomy.[1]

Apical Myectomy for Nonobstructive Apical HCM

In highly selected patients with apical HCM and severe dyspnea or angina (NYHA class III–IV) despite maximal medical therapy, apical myectomy may be considered (Class IIb). Ideal candidates have preserved ejection fraction (EF) and a small LV cavity size (LV end-diastolic volume <50 mL/m² and LV stroke volume <30 mL/m²). This procedure must be performed by experienced surgeons at comprehensive centers to reduce symptoms.[1] Observational data from patients undergoing transapical myectomy for severely symptomatic apical HCM demonstrate clinical improvement in 76% of patients, with long-term survival of 87% at 5 years and 74% at 10 years.[6]

Concomitant Surgical AF Ablation During Myectomy

For patients with HCM and atrial fibrillation who require surgical myectomy, concomitant surgical AF ablation (such as the Cox-Maze procedure or pulmonary vein isolation) is beneficial for rhythm control (Class IIa).[1] Surgical relief of the LVOT gradient and MR can limit or reverse negative atrial remodeling. In major surgical series, freedom from AF at 3 years was approximately 70% with concomitant surgical ablation. The full maze procedure has achieved higher 1-year freedom from AF recurrence (75%) compared with ablation alone (44%; P < 0.001).[1]

Advanced Heart Failure: LVAD and Cardiac Transplantation

Cardiac Transplantation

Assessment for cardiac transplantation is recommended (Class I) for patients with nonobstructive HCM and advanced heart failure (NYHA class III–IV despite GDMT) or with life-threatening ventricular arrhythmias refractory to maximal GDMT.[1][2]

Importantly, 20–50% of patients with HCM who develop advanced HF have preserved EF with restrictive physiology; therefore, transplant referral for HCM does not strictly require a reduced EF.[1] Posttransplant survival in patients with HCM is comparable to, and often superior to, patients with other forms of heart disease, with 1-, 5-, and 10-year overall survival rates of approximately 85%, 75%, and 61%, respectively.[1][6] The 2018 UNOS Heart Transplant Allocation Policy revisions introduced separate listing criteria specific to patients with HCM, significantly improving transplant access and waitlist times.[1]

LVAD Therapy

Continuous-flow left ventricular assist device (LVAD) therapy is reasonable as a bridge to transplantation (Class IIa) in patients with nonobstructive HCM and advanced HF who are candidates for heart transplantation.[1][2] While patients with HCM historically had higher risks of adverse outcomes (such as suction events and device thrombosis) due to smaller LV cavities and restrictive hemodynamics, better post-LVAD survival is observed in patients with larger LV cavities (>46–50 mm).[2]

Management Pivot at LVEF <50%

The 2024 AHA/ACC Guideline highlights a critical pivot in therapy when LVEF falls below 50%:[1][2]

  • Cardiac myosin inhibitors (e.g., mavacamten, aficamten) must be discontinued when systolic dysfunction is persistent (Class I, LOE: B-R); temporary interruption with resumption at a lower dose may be considered if LVEF recovers to >50%.
  • GDMT for heart failure with reduced ejection fraction (HFrEF) should be initiated (Class I).
  • Diagnostic testing for concomitant causes of systolic dysfunction (e.g., CAD) is required (Class I).
  • Cardiopulmonary exercise testing (CPET) should be utilized to quantify functional limitation and assess transplant candidacy (Class I).
  • Previously indicated negative inotropic agents (verapamil, diltiazem, disopyramide) should be reconsidered for discontinuation (Class IIa).
  • ICD placement can be beneficial (Class IIa).
  • Cardiac resynchronization therapy (CRT) can be beneficial to improve symptoms in patients with LBBB (Class IIa).

2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline Recommendations for Surgical Interventions

The following tables summarize current surgical recommendations.[1]

Invasive Treatment of Symptomatic Patients With Obstructive HCM

Class I
1. In patients with obstructive HCM who remain symptomatic despite GDMT, SRT in eligible patients, performed at experienced HCM centers, is recommended for relieving LVOTO. (LOE: B-NR)
2. In symptomatic patients with obstructive HCM who have associated cardiac disease requiring surgical treatment (e.g., anomalous papillary muscle, markedly elongated anterior mitral leaflet, intrinsic mitral valve disease, multivessel CAD, valvular aortic stenosis), surgical myectomy, performed at experienced HCM centers, is recommended. (LOE: B-NR)
3. In adult patients with obstructive HCM who remain severely symptomatic, despite GDMT and in whom surgery is contraindicated or the risk is considered unacceptable because of serious comorbidities or advanced age, alcohol septal ablation in eligible patients, performed at experienced HCM centers, is recommended. (LOE: C-LD)
Class IIb
4. In patients with obstructive HCM, earlier (NYHA class II) surgical myectomy performed at comprehensive HCM centers may be reasonable in the presence of additional clinical factors, including: (LOE: B-NR)
a. Severe and progressive pulmonary hypertension thought to be attributable to LVOTO or associated MR;
b. Left atrial enlargement with ≥1 episodes of symptomatic AF;
c. Poor functional capacity attributable to LVOTO as documented on treadmill exercise testing;
d. Children and young adults with very high resting LVOT gradients (>100 mm Hg).
5. For symptomatic patients with obstructive HCM, SRT in eligible patients, performed at experienced HCM centers, may be considered as an alternative to escalation of medical therapy after shared decision-making including risks and benefits of all treatment options. (LOE: C-LD)

Apical Myectomy in Nonobstructive HCM

Class IIb
1. In highly selected patients with apical HCM with severe dyspnea or angina (NYHA functional class III or class IV) despite maximal medical therapy, and with preserved EF and small LV cavity size (LV end-diastolic volume <50 mL/m² and LV stroke volume <30 mL/m²), apical myectomy by experienced surgeons at comprehensive centers may be considered to reduce symptoms. (LOE: C-LD)

Concomitant Surgical AF Ablation

Class IIa
1. In patients with HCM and AF who require surgical myectomy, concomitant surgical AF ablation procedure can be beneficial for AF rhythm control. (LOE: B-NR)

Advanced HF Management

Class I
1. In patients with HCM who develop systolic dysfunction with an LVEF <50%, GDMT for HF with reduced EF is recommended. (LOE: C-LD)
2. In patients with HCM and systolic dysfunction, diagnostic testing to assess for concomitant causes of systolic dysfunction (e.g., CAD) is recommended. (LOE: C-LD)
3. In patients with nonobstructive HCM and advanced HF (NYHA functional class III to class IV despite GDMT), CPET should be performed to quantify the degree of functional limitation and aid in selection of patients for heart transplantation or mechanical circulatory support. (LOE: B-NR)
4. In patients with nonobstructive HCM and advanced HF (NYHA functional class III to class IV despite GDMT) or with life-threatening ventricular arrhythmias refractory to maximal GDMT, assessment for heart transplantation in accordance with current listing criteria is recommended. (LOE: B-NR)
5. In patients with HCM who develop persistent systolic dysfunction (LVEF <50%), cardiac myosin inhibitors should be discontinued. (LOE: B-R)
Class IIa
6. For patients with HCM who develop systolic dysfunction (LVEF <50%), it is reasonable to discontinue previously indicated negative inotropic agents (specifically, verapamil, diltiazem, or disopyramide). (LOE: C-EO)
7. In patients with nonobstructive HCM and advanced HF (NYHA functional class III to class IV despite GDMT) who are candidates for heart transplantation, continuous-flow LVAD therapy is reasonable as a bridge to heart transplantation. (LOE: B-NR)
8. In patients with HCM and persistent LVEF <50%, ICD placement can be beneficial. (LOE: C-LD)
9. In patients with HCM and LVEF <50%, NYHA functional class II to class IV symptoms despite GDMT, and LBBB, CRT can be beneficial to improve symptoms. (LOE: C-LD)

2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines [7]

Recommendations for ICD Placement in High-Risk Patients With HCM Referenced studies that support the recommendations are summarized in the Online Data Supplement

Class I
1. In patients with HCM, application of individual clinical judgment is recommended when assessing the prognostic strength of conventional risk marker(s) within the clinical profile of the individual patient, as well as a thorough and balanced discussion of the evidence, benefits, and estimated risks to engage the fully informed patient’s active participation in ICD decision-making (Level of Evidence: C-EO)

2. For patients with HCM, and previous documented cardiac arrest or sustained VT, ICD placement is recommended (Level of Evidence: B-NR)

Class IIa
3. For adult patients with HCM with ≥1 major risk factors for SCD, it is reasonable to offer an ICD. These major risk factors include2,3,7–21(Figure 3, Table 7):(Level of Evidence: B-NR)

a. Sudden death judged definitively or likely attributable to HCM in ≥1 first-degree or close relatives who are ≤50 years of age; b. Massive LVH ≥30 mm in any LV segment; c. ≥1 Recent episodes of syncope suspected by clinical history to be arrhythmic (ie, unlikely to be of neurocardiogenic [vasovagal] etiology, or related to LVOTO); d. LV apical aneurysm, independent of size; e. LV systolic dysfunction (EF <50%). 4. For children with HCM who have ≥1 conventional risk factors, including unexplained syncope, massive LVH, NSVT, or family his-tory of early HCM-related SCD, ICD placement is reasonable after considering the relatively high complication rates of long-term ICD placement in younger patients(Level of Evidence: B-NR)

5. For patients ≥16 years of age with HCM and with ≥1 major SCD risk factors, discussion of the estimated 5-year sudden death risk and mortality rates can be useful during the shared decision-making process for ICD placemen(Level of Evidence: B-NR)

Class IIb
6. In select adult patients with HCM and without major SCD risk factors after clinical assessment, or in whom the decision to proceed with ICD placement remains otherwise uncertain, ICD may be considered in patients with extensive LGE by contrast-enhanced CMR imaging or NSVT present on ambulatory monitoring(Level of Evidence: B-NR)

7. In select pediatric patients with HCM in whom risk stratification is otherwise less certain, it may be useful to consider additional factors such as extensive LGE on contrast-enhanced CMR imaging and systolic dysfunction in risk stratification(Level of Evidence: C-LD)

Recommendations for Invasive Treatment of Symptomatic Patients With Obstructive HCM Referenced studies that support the recommendations are summarized in the Online Data Supplement

Class I
2. In symptomatic patients with obstructive HCM who have associated cardiac disease requiring surgical treatment (eg, associated anomalous papillary muscle, markedly elongated anterior mitral leaflet, intrinsic mitral valve disease, multivessel CAD, valvular aortic stenosis), surgical myectomy, performed at experienced centers,† is recommended(Level of Evidence: B-NR)
Class IIb
4. In patients with obstructive HCM, earlier (NYHA class II) surgical myectomy performed at comprehensive HCM centers (Table 3 and Table 4) may be reasonable in the presence of additional clinical factors, including3,11–22:(Level of Evidence: B-NR)

a.Severe and progressive pulmonary hyper-tension thought to be attributable to LVOTO or associated MR. b.Left atrial enlargement with ≥1 episodes of symptomatic AF c.Poor functional capacity attributable to LVOTO as documented on treadmill exercise testing. d.Children and young adults with very high resting LVOT gradients (>100 mm Hg). 5. For severely symptomatic patients with obstructive HCM, SRT in eligible patients,* performed at experienced centers† (Table 3 and Table 4), may be considered as an alter-native to escalation of medical therapy after shared decision-making including risks and benefits of all treatment options.(Level of Evidence: C-LD)

Recommendations for Management of Patients With Nonobstructive HCM With Preserved EF Referenced studies that support the recommendations are summarized in the Online Data Supplement

Class IIb
4. In highly selected patients with apical HCM with severe dyspnea or angina (NYHA class III or class IV) despite maximal medical therapy, and with preserved EF and small LV cavity size (LV end-diastolic volume <50 mL/m2 and LV stroke volume <30 mL/m2), apical myectomy by experienced surgeons at comprehensive centers may be considered to reduce symptoms(Level of Evidence: C-LD)

Recommendations for Management of Atrial Fibrillation Referenced studies that support the recommendations are summarized in the Online Data Supplement

Class IIa
7. In patients with HCM and AF who require surgical myectomy, concomitant surgical AF ablation procedure can be beneficial for AF rhythm control(Level of Evidence: B-NR)

Recommendations for Patients With HCM and Advanced HF Referenced studies that support the recommendations are summarized in the Online Data Supplement

Class I
4. In patients with nonobstructive HCM and advanced HF (NYHA class III to class IV despite guideline-directed therapy) or with life-threatening ventricular arrhythmias refractory to maximal guideline-directed therapy, assessment for heart transplantation in accordance with current listing criteria is recommended(Level of Evidence: B-NR)
Class IIa
6. In patients with nonobstructive HCM and advanced HF (NYHA functional class III to class IV despite GDMT) who are candidates for heart transplantation, continuous-flow LVAD therapy is reasonable as a bridge to heart transplantation(Level of Evidence: B-NR)

7. In patients with HCM and LVEF <50%, ICD placement can be beneficial(Level of Evidence: C-LD) 8. In patients with HCM and LVEF <50%, NYHA functional class II to class IV symptoms despite guideline-directed therapy, and LBBB, CRT can be beneficial to improve symptoms(Level of Evidence: C-LD)

2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy (DO NOT EDIT)[8]

Selection of Patients for Heart Transplantation (DO NOT EDIT) [8]

Class I
"1. Patients with advanced heart failure (end stage) and nonobstructive HCM not otherwise amenable to other treatment interventions, with EF less than or equal to 50% (or occasionally with preserved EF), should be considered for heart transplantation.[9][10] (Level of Evidence: B) "
"2. Symptomatic children with HCM with restrictive physiology who are not responsive to or appropriate candidates for other therapeutic interventions should be considered for heart transplantation.[11][12] (Level of Evidence: C) "
Class III (Harm)
"1. Heart transplantation should not be performed in mildly symptomatic patients of any age with HCM. (Level of Evidence: C) "

Septal Reduction Therapy (DO NOT EDIT)[8]

Class I
"1. Septal reduction therapy should be performed only by experienced operators in the context of a comprehensive HCM clinical program and only for the treatment of eligible patients with severe drug-refractory symptoms and LVOT obstruction.[13] (Level of Evidence: C)"
Class III (Harm)
"1. Septal reduction therapy should not be done for adult patients with HCM who are asymptomatic with normal exercise tolerance or whose symptoms are controlled or minimized on optimal medical therapy. (Level of Evidence: C) "
"2. Septal reduction therapy should not be done unless performed as part of a program dedicated to the longitudinal and multidisciplinary care of patients with HCM. (Level of Evidence: C) "
"3. Mitral valve replacement for relief of LVOT obstruction should not be performed in patients with HCM in whom septal reduction therapy is an option. (Level of Evidence: C) "

Sources

Septal Myectomy (DO NOT EDIT)

Class IIa
"1. Consultation with centers experienced in performing both surgical septal myectomy and alcohol septal ablation is reasonable when discussing treatment options for eligible patients with HCM with severe drug-refractory symptoms and LVOT obstruction. (Level of Evidence: C)"
"2. Surgical septal myectomy, when performed in experienced centers, can be beneficial and is the first consideration for the majority of eligible patients with HCM with severe drug-refractory symptoms and LVOT obstruction. (Level of Evidence: B)"
"3. Surgical septal myectomy, when performed at experienced centers, can be beneficial in symptomatic children with HCM and severe resting obstruction (>50 mm Hg) for whom standard medical therapy has failed. (Level of Evidence: C)"

Sources

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 Ommen SR, Ho CY, et al. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy. J Am Coll Cardiol. 2024;83(23):2324-2405. doi:10.1016/j.jacc.2024.02.014.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy. J Am Coll Cardiol. 2020;76(25):e159-e240. doi:10.1016/j.jacc.2020.08.045.
  3. ↑ 3.0 3.1 3.2 3.3 Maron BJ, Desai MY, Nishimura RA, et al. Management of Hypertrophic Cardiomyopathy: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022;79(4):390-414. doi:10.1016/j.jacc.2021.11.021.
  4. ↑ 4.0 4.1 Cui H, Schaff HV, Wang S, et al. Survival Following Alcohol Septal Ablation or Septal Myectomy for Patients With Obstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol. 2022;79(17):1647-1655. doi:10.1016/j.jacc.2022.02.032.
  5. ↑ Yokoyama Y, Shimoda T, Shimada YJ, et al. Alcohol Septal Ablation Versus Surgical Septal Myectomy of Obstructive Hypertrophic Cardiomyopathy: Systematic Review and Meta-Analysis. Eur J Cardiothorac Surg. 2023;63(3):ezad043. doi:10.1093/ejcts/ezad043.
  6. ↑ 6.0 6.1 Desai MY, Maurizi N, Biagini E, et al. Pathophysiology and Therapeutic Needs in Nonobstructive Hypertrophic Cardiomyopathy. JACC Heart Fail. 2025;13(11):102658. doi:10.1016/j.jchf.2025.102658.
  7. ↑ Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P (December 2020). "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". J Am Coll Cardiol. 76 (25): e159–e240. doi:10.1016/j.jacc.2020.08.045. PMID 33229116 Check |pmid= value (help).
  8. ↑ 8.0 8.1 8.2 8.3 Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW (2011). "2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Journal of the American College of Cardiology. 58 (25): e212–60. doi:10.1016/j.jacc.2011.06.011. PMID 22075469. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  9. ↑ Harris KM, Spirito P, Maron MS; et al. (2006). "Prevalence, clinical profile, and significance of left ventricular remodeling in the end-stage phase of hypertrophic cardiomyopathy". Circulation. 114 (3): 216–25. doi:10.1161/CIRCULATIONAHA.105.583500. PMID 16831987. Unknown parameter |month= ignored (help)
  10. ↑ Biagini E, Spirito P, Leone O; et al. (2008). "Heart transplantation in hypertrophic cardiomyopathy". Am. J. Cardiol. 101 (3): 387–92. doi:10.1016/j.amjcard.2007.09.085. PMID 18237606. Unknown parameter |month= ignored (help)
  11. ↑ Gajarski R, Naftel DC, Pahl E; et al. (2009). "Outcomes of pediatric patients with hypertrophic cardiomyopathy listed for transplant". J. Heart Lung Transplant. 28 (12): 1329–34. doi:10.1016/j.healun.2009.05.028. PMID 19782603. Unknown parameter |month= ignored (help)
  12. ↑ Towbin JA (2002). "Cardiomyopathy and heart transplantation in children". Curr. Opin. Cardiol. 17 (3): 274–9. PMID 12015478. Unknown parameter |month= ignored (help)
  13. ↑ van der Lee C, Scholzel B, ten Berg JM; et al. (2008). "Usefulness of clinical, echocardiographic, and procedural characteristics to predict outcome after percutaneous transluminal septal myocardial ablation". Am. J. Cardiol. 101 (9): 1315–20. doi:10.1016/j.amjcard.2008.01.003. PMID 18435964. Unknown parameter |month= ignored (help)
  14. ↑ Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation. 2008; 117: 2820–2840. PMID 18483207
  15. ↑ Vardas PE, Auricchio A, Blanc JJ, Daubert JC, Drexler H, Ector H; et al. (2007). "Guidelines for cardiac pacing and cardiac resynchronization therapy. The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association". Europace. 9 (10): 959–98. doi:10.1093/europace/eum189. PMID 17726043.
  16. ↑ Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW (2011). "2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Journal of the American College of Cardiology. 58 (25): 2703–38. doi:10.1016/j.jacc.2011.10.825. PMID 22075468. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  17. ↑ Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW (2011). "2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Journal of the American College of Cardiology. 58 (25): e212–60. doi:10.1016/j.jacc.2011.06.011. PMID 22075469. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
  18. ↑ Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM III, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices). Circulation. 2008; 117: 2820–2840. PMID 18483207
  19. ↑ Vardas PE, Auricchio A, Blanc JJ, Daubert JC, Drexler H, Ector H; et al. (2007). "Guidelines for cardiac pacing and cardiac resynchronization therapy. The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association". Europace. 9 (10): 959–98. doi:10.1093/europace/eum189. PMID 17726043.
  20. ↑ Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, Seidman CE, Towbin JA, Udelson JE, Yancy CW (2011). "2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Journal of the American College of Cardiology. 58 (25): 2703–38. doi:10.1016/j.jacc.2011.10.825. PMID 22075468. Retrieved 2011-12-19. Unknown parameter |month= ignored (help)
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