Survival After Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy

Abstract

Background-The clinical efficacy of alcohol septal ablation for obstructive hypertrophic cardiomyopathy (HCM) has been demonstrated, but the long-term effects of the procedure remain uncertain. This study examined the survival of patients after septal ablation performed in a tertiary HCM referral center. Methods and Results-We examined 177 patients (mean age, 64 years; 68% women) who underwent septal ablation at our institution. Over a follow-up of 5.7 years, survival free of all mortality was no different than the expected survival for a comparable general population, and similar to that of age-and sex-matched patients who underwent isolated surgical myectomy (8-year survival estimate, 79% versus 79%; Pϭ0.64). For the end point of documented sudden cardiac death or unknown cause of death, the incidence per 100 person-year follow-up was 1.31 (95% confidence interval, 0.60-2.38). Residual left ventricular outflow tract gradient after ablation was an independent predictor of long-term survival free of any death. Conclusions-In this nonrandomized study of carefully selected patients undergoing septal ablation by experienced operators in a tertiary referral HCM center, long-term survival was favorable and similar to that of an age-and sex-matched general population, and to patients undergoing surgical myectomy, as well, without an increased risk of sudden cardiac death. (Circulation. 2012;126:2374-2380.)

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

“…And, as survival after myectomy, survival after ASA is also comparable with that of general population [8,9]. These data support the notion that ASA may be another intervention which improves survival of patients with obstructive HCM and severe drug-refractory symptoms.…”

“…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].…”

45-year-old man with hypertrophic cardiomyopathy after alcohol ablation, progression to dilated cardiomyopathy (RCD code: III‑1B.8a)

“…Additionally, he was also started with off-label sildenafil with an aim for the reduction of significant pulmonary hypertension. Based on the literature and an experience the clinical efficacy of alcohol septal ablation for HCM is good in terms of symptoms relief but it's long-term effect remains uncertain [6]. Our patient underwent alcohol ablation of basal segment of interventricular septum due to symptoms resulting from LVOT obstruction.…”

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. In 2008 Kuhn et al published the results of 644 consecutive patients treated by ASA over a 10-year period.…”