Key result
Alcohol septal ablation matches DDD pacing for LVOT gradient reduction but yields greater symptom relief.
Why the study?
Does alcohol septal ablation reduce LVOTG and improve symptoms more than dual-chamber pacing in symptomatic patients with hypertrophic obstructive cardiomyopathy?
Cohort (n=76)
Yes
Does alcohol septal ablation reduce LVOTG and improve symptoms more than dual-chamber pacing in symptomatic patients with hypertrophic obstructive cardiomyopathy?
Absolute Event Rate: 49% vs 61%
p-value: p=0.264
Both alcohol septal ablation and dual-chamber pacing provide sustained, long-term reductions in left ventricular outflow tract gradients for patients with symptomatic hypertrophic obstructive cardiomyopathy.
Ablation may offer greater symptom relief than pacing in HOCM despite similar gradient reduction; leaves open optimal selection pending randomized trials.
INTRODUCTION: Nonpharmacological treatment of patients with hypertrophic obstructive cardiomyopathy (HOCM) comprises surgical myectomy (SME), alcohol septal ablation (ASA), and dual-chamber (DDD) pacing. The aim of the study was to compare the long-term effect of DDD pacing and ASA in symptomatic HOCM patients. PATIENTS AND METHODS: We evaluated retrospective data from three cardiocenters; there were 24 patients treated with DDD pacing included and 52 treated with ASA followed for 101 ± 49 and 87 ± 23 months, respectively. RESULTS: In the group treated with DDD pacing, the left ventricle outflow tract gradient (LVOTG) decreased from 82 ± 44 mmHg to 21 ± 21 mmHg, and NYHA class improved from 2.7 ± 0.5 to 2.1 ± 0.6 (both P < 0.001). In the ASA-treated group, a decline in LVOTG from 73 ± 38 mmHg to 24 ± 26 mmHg and reduction in NYHA class from 2.8 ± 0.5 to 1.7 ± 0.8 were observed (both P < 0.001). The LVOTG change was similar in both groups (P = 0.264), and symptoms were more affected by ASA (P = 0.001). CONCLUSION: ASA and DDD pacing were similarly effective in reducing LVOTG. The symptoms improvement was more expressed in patients treated with ASA.
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Krejčí et al. (2013) conducted a cohort in Hypertrophic Obstructive Cardiomyopathy (n=76). Alcohol septal ablation (ASA) vs. Dual-chamber (DDD) pacing was evaluated on Change in left ventricle outflow tract gradient (LVOTG) (p=0.264). Alcohol septal ablation and dual-chamber pacing similarly reduced left ventricle outflow tract gradient (P=0.264), though ablation resulted in more pronounced symptom improvement.
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