Outcomes of Alcohol Septal Ablation in Younger Patients With Obstructive Hypertrophic Cardiomyopathy

Liebregts, Max; Faber, Lothar; Jensen, Morten Kvistholm; Vriesendorp, Pieter A.; Januška, Jaroslav; Krejčí, Jan; Hansen, Peter Riis; Seggewiß, Hubert; Horstkotte, Dieter; Adlová, Radka; Bundgaard, Henning; Berg, Jurriën Ten; Veselka, Josef

doi:10.1016/j.jcin.2017.03.030

Cited by 58 publications

(40 citation statements)

References 18 publications

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“…It was also noteworthy that our rate of reintervention for LVOTO in the ≥18-year pacing group at 3.5% was clearly lower than in our ≥18 year old myectomy group at 15.6% ( P = 0.007) and clearly lower than comparable age range patients treated with ASA (reintervention rate 9.7%) 17 . In a large multicentre study of ASA, reintervention rate was higher still, 10.6% in the <51-year-olds and 10.4% in 51–64 year-olds, 19 and LVOT-gradients was 26 and 27 mmHg respectively 1 month after the procedure 19 . The 51–64-year-olds had 10 year survival of 80%, 19 which compares with our <65-year-old pacing group having a total survival at 10 years of 83%.…”

Section: Discussioncontrasting

confidence: 48%

“…In a large multicentre study of ASA, reintervention rate was higher still, 10.6% in the <51-year-olds and 10.4% in 51–64 year-olds, 19 and LVOT-gradients was 26 and 27 mmHg respectively 1 month after the procedure 19 . The 51–64-year-olds had 10 year survival of 80%, 19 which compares with our <65-year-old pacing group having a total survival at 10 years of 83%. In summary, the results from short AV delay pacing in our cohort with 100% complete follow-up give no support for the notion that short AV delay pacing is an inferior treatment approach to ASA or indeed in adult patients to myectomy.…”

Section: Discussionmentioning

confidence: 46%

“…These figures are substantially higher than the 0.28% sudden death rate observed in our pacing group. Periprocedural mortality is similar for myectomy and ASA, but 7–20% of patients subjected to ASA require permanent pacing, 7 when compared with around 4% after myectomy, 18 although recent ASA studies report lower pacing rates of 4% 19 . Short AV delay pacing is a reversible and non-destructive mode of therapy with lower periprocedural mortality and requiring fewer resources than surgery and ASA.…”

Section: Discussionmentioning

confidence: 99%

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Short atrioventricular delay pacing therapy in young and old patients with hypertrophic obstructive cardiomyopathy: good long-term results and a low need for reinterventions

et al. 2017

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AimsExamination of long-term results following different treatments in hypertrophic obstructive cardiomyopathy (HOCM) in a complete geographical cohort.Methods and resultsHOCM patients attending during 2002–13 in all 10 hospitals in the West Götaland Region, Sweden, were identified (n = 251), follow-up 14.4 (±8.9) years (mean ± SD), 121 managed medically, 42 treated with myectomy and 88 with short atrioventricular (AV) delay pacing as first interventional procedure. Post-intervention follow-up was 12.9 ± 8.7 years and 12.2 ± 5.0 years, respectively. Both intervention treatments improved New York Heart Association (NYHA) class and outflow gradients significantly. Patients treated with pacing were older (median age 64 vs. 43 years, P < 0.001). Freedom from disease-related death post-procedure at 5, 10, and 20 years were 93%, 80%, 56% vs. 93%, 93%, 57% in pacing and myectomy groups, respectively (log-rank P = 0.43). Survival after diagnosis was not different in patients just treated conservatively (P = 0.51 pacing/conservative; P = 0.39 myectomy/conservative). Reintervention for outflow gradients in patients ≥18 years at procedure occurred in 3.5% in pacing group and 15.6% in myectomy group (P = 0.007). Pacing therapy was equally effective in patients aged 13–64 years (n = 44), as in patients ≥65 years (n = 44): resting gradient pre-procedure and at last follow-up were median (IQR) 65 (71) and 12 (20) mmHg for <65 year-olds (P < 0.001), and 75 (64) and 14 (38) mmHg, respectively, for ≥65 year-olds (P < 0.001). New York Heart Association class improved significantly in both age ranges to 1.6 ± 0.6 and 1.8 ± 0.7, respectively (P < 0.001; P < 0.001).ConclusionShort AV delay pacing provided lasting satisfactory relief of symptoms and outflow obstruction in the majority of patients, with low risk of requiring reintervention. Our findings support the view that pacing therapy should be considered a valid option to treat patients with HOCM.

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Section: Discussioncontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

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Short atrioventricular delay pacing therapy in young and old patients with hypertrophic obstructive cardiomyopathy: good long-term results and a low need for reinterventions

et al. 2017

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“…This approach offers low procedural mortality and complications, substantial symptomatic improvement, with long‐term mortality similar to age and gender‐matched populations 2 . A surfeit of data has documented that postprocedural mortality is linearly correlated with the volume of alcohol administered during ASA 3,4 . Consequently, high‐volume ASA centers, most usually as part of multidisciplinary HOCM programs, have, over time, migrated to lower and lower alcohol volumes during ASA 2,3 …”

mentioning

confidence: 99%

“…A surfeit of data has documented that postprocedural mortality is linearly correlated with the volume of alcohol administered during ASA 3,4 . Consequently, high‐volume ASA centers, most usually as part of multidisciplinary HOCM programs, have, over time, migrated to lower and lower alcohol volumes during ASA 2,3 …”

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confidence: 99%

Fixed, high‐volume alcohol dose for septal ablation: High risk with no benefit

Kimmelstiel

Rowin

2020

Cathet Cardio Intervent

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Expert Article Analysis for:Outcomes of hypertrophic obstructive cardiomyopathy patients undergoing alcohol septal ablation with a standard 3 mL dose of ethanol: Focus on long-term safety Fixed, high-volume alcohol dose for septal ablation: High risk with no benefit Key Points• Alcohol volume is positively correlated with mortality following alcohol septal ablation (ASA).• Over time, there has been a trend to use lower volumes of alcohol for ASA. Most cases can and should be performed using 1-2 cc of alcohol.• The volume of alcohol utilized during septal ablation should be determined by anatomic and clinical features of the individual patient.Alcohol septal ablation (ASA) is a well-described therapy for highly symptomatic obstructive hypertrophic cardiomyopathy (HOCM) patients who are refractory to medical therapy. Current guidelines recommend ASA for older patients and those with comorbidities that would engender higher risk for surgical myectomy. 1 This approach offers low procedural mortality and complications, substantial symptomatic improvement, with long-term mortality similar to age and gender-matched populations. 2 A surfeit of data has documented that postprocedural mortality is linearly correlated with the volume of alcohol administered during ASA. 3,4 Consequently, high-volume ASA centers, most usually as part of multidisciplinary HOCM programs, have, over time, migrated to lower and lower alcohol volumes during ASA. 2,3 In this issue of Catheterization and Cardiovascular Interventions, Kashtanov and colleagues describe results in their patients undergoing ASA over a median of approximately 6 years. 5 They used a fixed dose of 3 ml of alcohol in each of their ASA cases, regardless of individual patient anatomy and reported permanent pacemaker (PPM) implantation in 16% of their population, relief of obstruction in approximately 75% with almost 20% of patients requiring repeat intervention forrelief of obstruction, and rates of long-term survival similar to that of age and gender-matched Russian population. Although the approach of a fixed 3 ml dose of alcohol is intriguing in its simplicity, there are substantial limitations to such a strategy that limit its utility.The authors implemented a fixed 3 ml of alcohol dose on the basis of experience with "the first few patients" in their center. Unfortunately, this ignores prior and subsequent data correlating high alcohol doses with mortality while procedural efficacy and salutary outcomes have been documented with migration to much lower doses of alcohol-often one-third that which the authors have employed. In fact, recent European and American data have reported mean alcohol doses of 1-2 ml/case. [2][3][4] Moreover, the larger point is ASA, which is recommended for the relatively small proportion of HOCM patients with dynamic LVOT obstruction, who are highly symptomatic (NYHA Class III-IV) and refractory to medical therapy.The majority of patients currently reported on were at baseline, minimally symptomatic (more than half the population were NYHA Class ...

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Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

Khan¹,

Dangas²,

Sigwart³

2022

Interventional Cardiology

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Outcomes of Alcohol Septal Ablation in Younger Patients With Obstructive Hypertrophic Cardiomyopathy

Abstract: ASA in younger patients with obstructive hypertrophic cardiomyopathy was safe and effective for relief of symptoms at long-term follow-up. The authors propose that the indication for ASA can be broadened to younger patients.

Cited by 58 publications

References 18 publications

Short atrioventricular delay pacing therapy in young and old patients with hypertrophic obstructive cardiomyopathy: good long-term results and a low need for reinterventions

Short atrioventricular delay pacing therapy in young and old patients with hypertrophic obstructive cardiomyopathy: good long-term results and a low need for reinterventions

Fixed, high‐volume alcohol dose for septal ablation: High risk with no benefit

Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

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