Choice of Septal Reduction Therapies and Alcohol Septal Ablation

Fifer, Michael A.

doi:10.1016/j.ccl.2018.08.009

Cited by 8 publications

(3 citation statements)

References 66 publications

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“…Additionally, the extent of post-ASA myocardial scar tissue should not induce significant arrhythmogenic events or heart failure. It is important to note, however, that apart from the amount of injected alcohol, a range of factors including, for example, anatomy of the septal branches, mechanism of subaortic dynamic obstruction and interplay with the mitral apparatus, papillary muscles abnormalities, magnitude of septal thickness, and septal hypertrophy geometry play important roles in decision-making to tailor optimal therapy for each individual HOCM patient [21][22][23][24][25]. Since these and other unmeasured factors were not taken into account in our study it is impossible to establish a specific alcohol dose suitable for all HOCM patients treated with ASA.…”

Section: Discussionmentioning

confidence: 99%

Alcohol dose in septal ablation for hypertrophic obstructive cardiomyopathy

Veselka

Faber

Liebregts

et al. 2021

International Journal of Cardiology

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Background: The aim of this study was to evaluate short-and long-term outcomes related to dose of alcohol administered during alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy (HOCM). Current guidelines recommend using 1-3 mL of alcohol administered in the target septal perforator artery, but this recommendation is based more on practical experience of interventionalists rather than on systematic evidence. Methods: We included 1448 patients and used propensity score to match patients who received a low-dose (1.0-1.9 mL) versus a high-dose (2.0-3.8 mL) of alcohol during ASA. Results: The matched cohort analysis comprised 770 patients (n = 385 in both groups). There was a similar occurrence of 30-day post-procedural adverse events (13% vs. 12%; p = 0.59), and similar all-cause mortality rates (0.8% vs. 0.5%; p = 1) in the low-dose group and the high-dose group, respectively. In the long-term follow-up (5.4 ± 4.5 years), a total of 110 (14%) patients died representing 2.58 deaths and 2.64 deaths per 100 patientyears in the low dose and the high dose group (logrank, p = 0.92), respectively. There were no significant differences in the long-term dyspnea and left ventricular outflow gradient between the two groups. Patients treated with a low-dose of alcohol underwent more subsequent septal reduction procedures (logrank, p = 0.04). Conclusions: Matched HOCM patients undergoing ASA with a low-dose (1.0-1.9 mL) or a high-dose (2.0-3.8 mL) of alcohol had similar short-and long-term outcomes. A higher rate of repeated septal reduction procedures was observed in the group treated with a low-dose of alcohol.

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Section: Discussionmentioning

confidence: 99%

Alcohol dose in septal ablation for hypertrophic obstructive cardiomyopathy

Veselka

Faber

Liebregts

et al. 2021

International Journal of Cardiology

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“…Therefore, these high-risk patients should be considered candidates for ICD implantation and relief of LV outflow obstruction to decrease the overall risk burden 6 7 12. However, there is an ongoing debate as to whether ASA-induced scar of the basal IVS is an appropriate therapy for these patients 28–30. There are at least two uncertainties concerning ASA that should be considered.…”

Section: Discussionmentioning

confidence: 99%

Alcohol septal ablation in patients with severe septal hypertrophy

Veselka

Jensen

Liebregts

et al. 2019

Heart

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ObjectiveThe current guidelines suggest alcohol septal ablation (ASA) is less effective in hypertrophic obstructive cardiomyopathy (HOCM) patients with severe left ventricular hypertrophy, despite acknowledging that systematic data are lacking. Therefore, we analysed patients in the Euro-ASA registry to test this statement.MethodsWe compared the short-term and long-term outcomes of patients with basal interventricular septum (IVS) thickness <30 mm Hg to those with ≥30 mm Hg treated using ASA in nine European centres.ResultsA total of 1519 patients (57±14 years, 49% women) with symptomatic HOCM were treated, including 67 (4.4%) patients with IVS thickness ≥30 mm. The occurrence of short-term major adverse events were similar in both groups. The mean follow-up was 5.4±4.3 years and 5.1±4.1 years, and the all-cause mortality rate was 2.57 and 2.94 deaths per 100 person-years of follow-up in the IVS <30 mm group and the IVS ≥30 mm group (p=0.047), respectively. There were no differences in dyspnoea (New York Heart Association class III/IV 12% vs 16%), residual left ventricular outflow tract gradient (16±20 vs 16±16 mm Hg) and repeated septal reduction procedures (12% vs 18%) in the IVS <30 mm group and IVS ≥30 mm group, respectively (p=NS for all).ConclusionsThe short-term results and the long-term relief of dyspnoea, residual left ventricular outflow obstruction and occurrence of repeated septal reduction procedures in patients with basal IVS ≥30 mm is similar to those with IVS <30mm. However, long-term all-cause and cardiac mortality rates are worse in the ≥30 mm group.

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“…Myectomy is favored for patients who are younger, have severe septal hypertrophy (> 30 mm) [ 26 , 28 ], require surgical intervention for other cardiac conditions (i.e., mitral valve abnormalities), or have a preexisting left bundle branch block. [ 29 ]…”

Section: Conventional Therapy For Hypertrophic Cardiomyopathy With Ob...mentioning

confidence: 99%

Contemporary Therapies and Future Directions in the Management of Hypertrophic Cardiomyopathy

et al. 2022

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Hypertrophic cardiomyopathy (HCM) is a genetic disorder caused by pathogenic variants in sarcomeric genes, leading to left ventricular hypertrophy and complex phenotypic heterogeneity. While HCM is the most common inherited cardiomyopathy, pharmacological treatment options have previously been limited and were predominantly directed towards symptom control owing to left ventricular outflow obstruction. These therapies, including beta blockers, calcium channel blockers, and disopyramide, have not been shown to affect the natural history of the disease, which is of particular concern for younger patients who have an increased lifetime risk of experiencing arrhythmias, heart failure, and sudden cardiac death. Increased knowledge of the genetic mechanisms underlying this disease in recent years has led to the development of targeted, potentially disease-modifying therapies for both obstructive and nonobstructive phenotypes that may help to prevent or ameliorate left ventricular hypertrophy. In this review article, we will define the etiology and clinical phenotypes of HCM, summarize the conventional therapies for obstructive HCM, discuss the emerging targeted therapies as well as novel invasive approaches for obstructive HCM, describe the therapeutic advances for nonobstructive HCM, and outline the future directions for the treatment of HCM.

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Choice of Septal Reduction Therapies and Alcohol Septal Ablation

Cited by 8 publications

References 66 publications

Alcohol dose in septal ablation for hypertrophic obstructive cardiomyopathy

Alcohol dose in septal ablation for hypertrophic obstructive cardiomyopathy

Alcohol septal ablation in patients with severe septal hypertrophy

Contemporary Therapies and Future Directions in the Management of Hypertrophic Cardiomyopathy

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