Outcomes and Complications of alcohol septal ablation for younger patients with hypertrophic obstructive cardiomyopathy: a single-centre study

Abstract

Backgrounds: Hypertrophic cardiomyopathy (HCM) is a genetic disorder of cardiac muscle with a heterogeneous clinical course. Alcohol septal ablation is a treatment option for severely symptomatic drug-refractory hypertrophic obstructive cardiomyopathy. This study aimed to determine the outcome of alcohol septal ablation in 20 patients from a single center in Iraq. Methods: Twenty patients with age less than 60 years had undergone alcohol septal ablation between May 2013 and February 2019 at Nasiriya Heart Centre. Patients were selected for alcohol septal ablation depending on the clinical and angiographic suitability of septal perforator branches. Clinical, electrocardiographic, and echocardiographic parameters were evaluated in the periprocedural period and during follow-up. Results: Only three patients (15 %) remained in NYHA class III after 6 months of follow-up, one of them underwent repeated alcohol septal ablation with successful improvement at 6 months follow-up, and the other two patients awaiting reevaluation at 6 months to decide for repeating ASA. Significant reduction of left ventricle outflow gradients (LVOTG) and septal thickness were observed during 6 months follow-up. Beyond 6 months, except for 3 patients, there was no further decrease in either septal thickness or LVOTG noted. The incidence of right bundle branch block (RBBB) after ASA was 45 % % and 3 patients (15 %) needed PPM implantation. There was no cardiovascular death on follow-up. Conclusion: Alcohol septal ablation is a safe and effective option for severely symptomatic patients, less than 60m years with HOCM because of its low risk and its significant clinical, echocardiographic, and hemodynamic improvement. The overall in-hospital adverse cardiovascular events were low and few patients required in-hospital permanent pacemaker implantation.