Long-Term Outcome of Alcohol Septal Ablation in Patients With Obstructive Hypertrophic Cardiomyopathy

Abstract

Background-The impact of alcohol septal ablation (ASA)-induced scar is not known. This study sought to examine the long-term outcome of ASA among patients with obstructive hypertrophic cardiomyopathy. Methods and Results-Ninety-one consecutive patients (aged 54Ϯ15 years) with obstructive hypertrophic cardiomyopathy underwent ASA. Primary study end point was a composite of cardiac death and aborted sudden cardiac death including appropriate cardioverter-defibrillator discharges for fast ventricular tachycardia/ventricular fibrillation. Secondary end points were noncardiac death and other nonfatal complications. Outcomes of ASA patients were compared with 40 patients with hypertrophic cardiomyopathy who underwent septal myectomy. During 5.4Ϯ2.5 years, primary and/or secondary end points were seen in 35 (38%) ASA patients of whom 19 (21%) patients met the primary end point. The 1-, 5-, and 8-year survival-free from the primary end point was 96%, 86%, and 67%, respectively in ASA patients versus 100%, 96%, and 96%, respectively in myectomy patients during 6.6Ϯ2.7 years (log-rank, Pϭ0.01). ASA patients had a Ϸ5-fold increase in the estimated annual primary end point rate (4.4% versus 0.9%) compared with myectomy patients. In a multivariable model including a propensity score, ASA was an independent predictor of the primary end point (unadjusted hazard ratio, 5.2; 95% CI, 1.2 to 22.1; Pϭ0.02 and propensity score-adjusted hazard ratio, 6.1; 95% CI, 1.4 to 27.1; Pϭ0.02). Conclusions-This study shows that ASA has potentially unwanted long-term effects. This poses special precaution, given the fact that ASA is practiced worldwide at increasing rate. We recommend myectomy as the preferred intervention in patients with obstructive hypertrophic cardiomyopathy. (Circ Heart Fail. 2010;3:362-369.)

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

“…The relatively better survival of the ASA group in this study vs. several previous reports may be explained by the fact that patients in the ASA group of our study were younger (mean age: 49.8 years) than those from the other studies (mean age: 54-64 years) [8,[25][26][27]. There were reports demonstrating the survival advantage of patients younger than 60 years or 65 years [25,28].…”

Optimal gradient reduction after alcohol septal ablation: a case report with anatomical and practical determinants

“…This may be important since higher outflow gradients after ASA are associated with a less favourable long-term haemodynamic outcome [6]. Additionally, even though metaanalyses have shown comparable long-term outcome between ASA and myectomy, in a recently published single-centre study, a higher rate of aborted sudden cardiac death was found after ASA compared with myectomy and therefore myectomy was advised as the preferred treatment [3].…”

“…However, gradient reduction after ASA was slightly less favourable [1,2] and in a singlecentre study a higher rate of aborted sudden cardiac death was found [3]. The following case report illustrates the importance of coronary anatomy and infarction location in determining the outcome after ASA.…”

Alcohol septal ablation in obstructive hypertrophic cardiomyopathy: Four years of experience at a reference center

“…Such fears were heightened by some small observational studies, 32,33 but these were contradicted by other similar studies that indicated the technique was safe. 34,35 These conflicting results, and the lack of sufficient evidence, have created confusion that can only be resolved by large studies of patients treated by ASA with long-term outcomes and by meta-analyses comparing the results of the two techniques.…”