Complications of low‐dose, echo‐guided alcohol septal ablation

Veselka, Josef; Zemánek, David; Tomašov, Pavol; Homolová, Stanislava; Adlová, Radka; Tesař, David

doi:10.1002/ccd.22326

Cited by 18 publications

(23 citation statements)

References 14 publications

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“…In this issue of the Journal, Veselka et al document their experience regarding complications associated with ASA using relatively smaller volumes of infused ethanol [2]. Prior data from a randomized study from the same institution documented that lower volumes of ethanol had similar salutary effects in diminishing both the left ventricular outflow gradient (LVOTG) and symptom density when compared with those patients randomized to receive a higher volume of alcohol [3].…”

supporting

confidence: 72%

Reducing arrhythmic complications following alcohol septal ablation—The utility of lower doses of ethanol

Kimmelstiel

2010

Cathet Cardio Intervent

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supporting

confidence: 72%

Reducing arrhythmic complications following alcohol septal ablation—The utility of lower doses of ethanol

Kimmelstiel

2010

Cathet Cardio Intervent

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“…90, 91 The precise identification of the target septal region has permitted injection of less alcohol without compromising the hemodynamic result. 74,75, 92 Although it is evident that complications decrease with increasing experience, the upper range of reported complications is unacceptably high. 67 Proper training and institutional organization should ensure the safety of alcohol septal ablation, and a deep understanding and extensive experience in clinical assessment and treatment of HOCM patients should be a prerequisite for institutions that offer alcohol septal ablation.…”

Section: Complicationsmentioning

confidence: 99%

A Decade of Percutaneous Septal Ablation in Hypertrophic Cardiomyopathy

Rigopoulos

Seggewiß

2011

Circ J

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Percutaneous septal ablation has emerged as a less invasive treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). In the past decade, the availability of this sophisticated technique has revived the interest of cardiologists in left ventricular outflow tract obstruction, which led to the recognition that most patients with HCM have the obstructive type. Follow-up studies have already shown the safety and efficacy of the procedure, which offers symptomatic relief in most patients. Long-term survival is comparable to historical reports after surgical myectomy. Complications are rare and can be further reduced with increased experience of the operators, and the theoretical concern for possible ventricular arrhythmogenicity of the myocardial scar has not been documented by the existing data. Although there are still no randomized trials, percutaneous septal ablation is undeniably a viable alternative for patients with HOCM. (Circ J 2011; 75: 28 - 37)

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“…It should be kept in mind, however, that the post-ASA gradient cannot be regarded as a reliable end point even for basal obstruction. 29 Regardless of the gradient, satisfactory ablation is achieved when sufficient ethanol deposits in septal myocardium attributable to intraventricular obstruction are confirmed by simultaneous TTE. 5 At any rate, latent gradients should be evaluated by the combination of multiple provocation tests which provide different types of modification to the hypertrophied LV because it has often been shown that some patients have susceptibility to one specific provocation.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcome of Alcohol Septal Ablation With Confirmation by Nitroglycerin Test for Drug-Refractory Hypertrophic Obstructive Cardiomyopathy With Labile Left Ventricular Outflow Obstruction

Kitamura

Takayama

Matsuda

et al. 2015

The American Journal of Cardiology

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Careful evaluation, including provocation tests, is needed to specify an indication for septal reduction therapy in patients with drug-refractory hypertrophic obstructive cardiomyopathy. This study aimed to evaluate the outcome of alcohol septal ablation (ASA) using an intravenous nitroglycerin test (IV-NTG). Of consecutive 156 patients, after excluding cases of severe valvular disease and repeat septal reduction therapy, we investigated the clinical characteristics of patients with labile obstruction (n = 32) and the outcomes after ASA using the IV-NTG test; comparisons were made with those exhibiting basal obstruction (a resting gradient of ≥30 mm Hg). The patients with labile obstruction had less left ventricular mass (141 ± 47 vs 182 ± 59 g, p = 0.003) and less brain natriuretic peptide values (414 ± 576 vs 744 ± 625 pg/ml, p <0.001) than those with basal obstruction. Immediately after ASA, the gradients improved from 15 ± 7 to 5 ± 5 mm Hg and the IV-NTG-provoked gradients improved from 74 ± 25 to 13 ± 9 mm Hg, respectively. At 1-year follow-up, the New York Heart Association functional class had improved from 2.7 ± 0.5 to 1.3 ± 0.5. There was no sudden cardiac death during the follow-up period (5.1 ± 3.0 years), and 8-year survival free from cardiovascular death was 94%. In conclusion, patients with labile obstruction had less-severe left ventricular hypertrophy but exhibited symptoms comparable to those with basal obstruction. The IV-NTG test is a useful method for rapidly confirming acute reduction of the latent gradient after the ASA procedure, and the outcome of ASA for labile obstruction was favorable.

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Complications of low‐dose, echo‐guided alcohol septal ablation

Abstract: This study demonstrates the same early incidence of complete heart block requiring permanent pacemaker implantation (4%) and sustained ventricular arrhythmias following low-dose, echo-guided ASA.

Cited by 18 publications

References 14 publications

Reducing arrhythmic complications following alcohol septal ablation—The utility of lower doses of ethanol

Reducing arrhythmic complications following alcohol septal ablation—The utility of lower doses of ethanol

A Decade of Percutaneous Septal Ablation in Hypertrophic Cardiomyopathy

Clinical Characteristics and Outcome of Alcohol Septal Ablation With Confirmation by Nitroglycerin Test for Drug-Refractory Hypertrophic Obstructive Cardiomyopathy With Labile Left Ventricular Outflow Obstruction

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