Long-term outcome of repeated septal reduction therapy after alcohol septal ablation for hypertrophic obstructive cardiomyopathy: insight from the Euro-ASA registry

Veselka, Josef; Faber, Lothar; Liebregts, Max; Cooper, Robert; Januška, Jaroslav; Krejčí, Jan; Dąbrowski, M; Hansen, Peter Riis; Seggewiß, Hubert; Horstkotte, Dieter; Hansvenclová, Eva; Bundgaard, Henning; Berg, Jurriën Ten; Jensen, Morten Kvistholm

doi:10.5114/aoms.2020.97969

Cited by 11 publications

(5 citation statements)

References 8 publications

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“…Although the overall survival of propensity-matched patients is similar, ASA is associated with a higher re-intervention (35% vs. 1%) due to persistent IVG, and higher pacemaker implantation rate than in SM [ 63 ]. Even though repeated septal reduction therapy after ASA was not associated with a higher risk of major cardiovascular events over a long-term follow-up, a significant percentage of the patients enrolled in the EURO-ASA required pacemaker implantation [ 64 ]. The periprocedural complication rate can be reduced by targeting the myocardial area and by reducing the amount of alcohol injected.…”

Section: Discussionmentioning

confidence: 99%

Targeting Alcohol Septal Ablation in Patients with Obstructive Hypertrophic Cardiomyopathy Candidates for Surgical Myectomy: Added Value of Three-Dimensional Intracoronary Myocardial Contrast Echocardiography

Canna

Scarfò

Arendar

et al. 2021

JCM

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Background: Myocardial contrast two-dimensional echocardiography (MC-2DE) is widely used to address alcohol septal ablation (ASA) in obstructive hypertrophic cardiomyopathy (HCM). Owing to its limited cut-planes, MC-2DE may inaccurately identify the contrast misplacement associated with an unsuccessful or complicated ASA outcome. Objective: The aim of this study was to assess the added value of myocardial contrast three-dimensional echocardiography (MC-3DE) compared with MC-2DE to identify the appropriate matching between the target septal zone (TSZ) and coronary artery branch for safe and long-term effective ASA in HCM patients. Methods: A consecutive series of 52 symptomatic obstructive HCM patients referred for isolated surgical myectomy (SM) was analyzed with MC-2DE and MC-3DE following injection of echocontrast into one or more septal branches. MC-2DE and MC-3DE patterns were categorized according to complete (Type 1) or incomplete (Type 2) TSZ covering, high-risk (Type 3) exceeding TSZ, or life-threatening outside TSZ distribution (Type 4). Results: MC-2DE per patient analysis showed a Type 1 pattern in 32 patients and Types 2–4 in the remaining 20 patients; subsequent MC-3DE analysis provided a re-phenotyping of MC-2DE findings in 22 of the 52 patients (42%), showing a high-risk Type 2 pattern in 17 of the 32 patients with Type 1, and a new life-threatening Type 4 in three patients with Type 2, respectively. All patients with MC-3DE Type 1 pattern underwent safe and effective ASA with a long-term uneventful follow-up, while the remaining patients underwent SM. Conclusions: Refining high risk or life-threatening contrast misplacement, MC-3DE is more accurate than conventional MC-2DE to target safe and long-term effective septal reduction with ASA in obstructive HCM patients referred for isolated SM.

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Section: Discussionmentioning

confidence: 99%

Targeting Alcohol Septal Ablation in Patients with Obstructive Hypertrophic Cardiomyopathy Candidates for Surgical Myectomy: Added Value of Three-Dimensional Intracoronary Myocardial Contrast Echocardiography

Canna

Scarfò

Arendar

et al. 2021

JCM

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“…[1][2][3][4]144 For patients with SSM treatment failure (residual obstruction) or postoperative recurrence of PTSMA, PTSMA can be considered again. 145 Alcohol septal ablation (ASA) is mainly used currently which is the classic PTSMA using anhydrous alcohol (96-99% ethanol) for chemo-ablation and blocking the septal branch artery, resulting in regional myocardial necrosis, thereby eliminating interventricular septal hypertrophy and reducing LVOTO. PTSMA can significantly reduce the peak LVOT pressure gradient, alleviate LVOTO and resolve MR, thereby improving patient symptoms and cardiac function, and improving exercise tolerance and quality of life.…”

Section: Nondihydropyridine Calcium Channel Blockers (Ccbs)mentioning

confidence: 99%

“…Specific indications for percutaneous transluminal septal myocardial ablation (PTSMA) include patients who meet indications for SRT but cannot undergo surgery due to advanced age or severe comorbidities, patients at higher risk or with contraindications to surgery, or patients unwilling to undergo surgery, for whom it is recommended to perform PTSMA 1–4,144 . For patients with SSM treatment failure (residual obstruction) or postoperative recurrence of PTSMA, PTSMA can be considered again 145 . Alcohol septal ablation (ASA) is mainly used currently which is the classic PTSMA using anhydrous alcohol (96–99% ethanol) for chemo-ablation and blocking the septal branch artery, resulting in regional myocardial necrosis, thereby eliminating interventricular septal hypertrophy and reducing LVOTO.…”

Section: Drug Therapy For Patients With Symptomatic Obstructive Hyper...mentioning

confidence: 99%

Management of hypertrophic cardiomyopathy

Zhang,

Adamo,

Zou

et al. 2024

Journal of Cardiovascular Medicine

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Hypertrophic cardiomyopathy is an important cause of heart failure and arrhythmias, including sudden death, with a major impact on the healthcare system. Genetic causes and different phenotypes are now increasingly being identified for this condition. In addition, specific medications, such as myosin inhibitors, have been recently shown as potentially able to modify its symptoms, hemodynamic abnormalities and clinical course. Our article aims to provide a comprehensive outline of the epidemiology, diagnosis and treatment of hypertrophic cardiomyopathy in the current era.

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“… 17 ASA is associated with the risk of requirement of permanent pacemaker therapy and the need for repeated procedures, although outcomes thereafter are still favourable. 18 , 19 …”

Section: Current Treatment Options For Obstructive Hcmmentioning

confidence: 99%

“…17 ASA is associated with the risk of requirement of permanent pacemaker therapy and the need for repeated procedures, although outcomes thereafter are still favourable. 18,19 SM represents the gold standard of treatment for symptomatic obstructive HCM in high-volume dedicated HCM centres of excellence, with a post-operative 30-day mortality of 0.5%. Longterm improvement in symptomatic status is reported in more than 90% of patients.…”

Section: Pharmacological Therapymentioning

confidence: 99%

Left ventricular outflow tract obstruction in hypertrophic cardiomyopathy and the impact of mavacamten

Mathai

Williams

2022

Therapeutic Advances in Chronic Disease

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Hypertrophic cardiomyopathy (HCM) is a common genetic disorder characterised by unexplained left ventricular hypertrophy. Left ventricular outflow tract obstruction is an integral component of the disease, often resulting in significant symptoms, but also carrying a risk of progression to heart failure and death. Advancements in our understanding of the pathophysiology of HCM have led to the development of new therapies targeting the molecular basis of the disease at the level of the cardiac sarcomere, the basic contractile apparatus of the myocardium. Myosin modulators are a novel class of small molecules which target cardiac myosins directly to modulate cardiac contractility. The myosin inhibitors present the first advancement in pharmacological management of obstructive HCM in almost 35 years, with a growing body of evidence for the safety, tolerability and efficacy of mavacamten, and to a lesser extent aficamten. The aim of this review is to summarise the current management of patients with obstructive HCM and review the most recent available data from clinical trials pertaining to myosin inhibition.

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Long-term outcome of repeated septal reduction therapy after alcohol septal ablation for hypertrophic obstructive cardiomyopathy: insight from the Euro-ASA registry

Cited by 11 publications

References 8 publications

Targeting Alcohol Septal Ablation in Patients with Obstructive Hypertrophic Cardiomyopathy Candidates for Surgical Myectomy: Added Value of Three-Dimensional Intracoronary Myocardial Contrast Echocardiography

Targeting Alcohol Septal Ablation in Patients with Obstructive Hypertrophic Cardiomyopathy Candidates for Surgical Myectomy: Added Value of Three-Dimensional Intracoronary Myocardial Contrast Echocardiography

Management of hypertrophic cardiomyopathy

Left ventricular outflow tract obstruction in hypertrophic cardiomyopathy and the impact of mavacamten

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