Outcome of Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy

Abstract

Background-The clinical efficacy of alcohol septal ablation for drug-refractory hypertrophic cardiomyopathy remains unclear. This study examines the outcome of alcohol septal ablation performed at a tertiary hypertrophic cardiomyopathy referral center. Methods and Results-Among 601 patients with severely symptomatic obstructive hypertrophic cardiomyopathy referred for alcohol septal ablation or myectomy from 1998 to 2006, 138 patients (median age, 64 years; 39% men) chose to undergo ablation. Procedural complications included death in 1.4%, sustained ventricular arrhythmias in 3%, tamponade in 3%, and pacemaker implantation in 20%. This rate was higher than a combined complication rate of 5% in age-and gender-matched patients who had undergone septal myectomy at Mayo Clinic (PϽ0.0001). Four-year survival free of all mortality was 88.0% (95% confidence interval, 79.4 to 97.5%), which was similar to that of the age-and gender-matched patients who had undergone myectomy (Pϭ0.18). Six patients had documented ventricular arrhythmias after ablation, 4 of whom had successful intervention. Four-year survival free of death and severe New York Heart Association class III/IV symptoms after septal ablation was 76.4%, and 71 patients (51%) became asymptomatic. Myectomy patients Յ65 years of age had significantly better survival free of death and severe symptoms (Pϭ0.01). Conclusions-Alcohol septal ablation is an efficacious procedure if performed in an experienced institution and may resolve symptoms in a subset of patients with obstructive hypertrophic cardiomyopathy. However, the procedural complication rate exceeds that of myectomy.

Survival after alcohol septal ablation versus conservative therapy in obstructive hypertrophic cardiomyopathy

“…However, we are still not sure whether this technique extends longevity of its target patients. Results from several studies suggest that ASA can extend longevity of patients with HCM [6][7][8][9][10][11][12]. Here, we extended evidence for this notion by directly comparing the survival of patients undergoing ASA vs. a group of conservatively treated patients with comparable pressure gradient and limiting symptoms.…”

“…Studies have demonstrated that survival rates after ASA and myectomy in experienced centers were similar [6][7][8]. And, as survival after myectomy, survival after ASA is also comparable with that of general population [8,9].…”

Right ventricle myectomy

“…In addition to diastolic dysfunction, septal scarring from ASA may contribute to rhythm abnormalities. An earlier Mayo Clinic study also showed a ventricular tachyarrhythmia and complications rate of 20% with ASA (31).…”

Catheter Treatment for Hypertrophic Obstructive Cardiomyopathy

“…Sorajja et al 10 conclude that "in patients Ͻ65 years old, symptom relief is better after myectomy." I beg to differ.…”