Key result
Percutaneous alcohol septal ablation significantly reduced baseline left ventricular outflow tract gradient from 75 mmHg to 25 mmHg (P<0.003) and improved functional class.
Why the study?
Does percutaneous alcohol septal ablation improve functional class and reduce left ventricular outflow tract gradient in patients with medically refractory obstructive hypertrophic cardiomyopathy?
Observational (n=23)
Does percutaneous alcohol septal ablation improve functional class and reduce left ventricular outflow tract gradient in patients with medically refractory obstructive hypertrophic cardiomyopathy?
p-value: p=<0.003
Percutaneous alcohol septal ablation significantly reduces left ventricular outflow tract gradient and improves functional class in patients with medically refractory obstructive hypertrophic cardiomyopathy.
May warrant consideration in selected obstructive HCM cases; leaves open need for randomized trials versus myectomy.
Background: Percutaneous septal ablation is a therapeutic option for patients with obstructive hypertrophic cardiomyopathyrefractory to optimal medical therapy. However, results of initial persistence and long-term safety are still controversial.Objectives: The aim of this study was to report percutaneous alcohol septal ablation technique, clinical and functional outcome,cardiovascular events and its impact on long-term follow-up.Methods: A total of 23 patients were included in the study. Functional class (FC), left ventricular outflow tract gradient beforeand after the procedure and long-term cardiovascular events were evaluated.Results: Median follow-up was 52 months (IR 33-72). All patients were in FC III or IV prior to the procedure, under maximumtolerated medical therapy. The procedure was successful in 91% of cases, with 85% of patients currently in FC I and 15% inFC II. Baseline left ventricular outflow tract gradient decreased from 75 mmHg (95% CI 51-89) to 25 mmHg (95% CI 10-37)(p<0.003) and with Valsalva maneuver from 118 mmHg (95% CI 88-152) to 38 mmHg (IC 95% 16-69) (p<0.0002), persistingin the long-term follow-up. During hospitalization, two patients presented with complete atrioventricular block requiringpermanent pacemaker implantation. No cardiovascular deaths occurred during follow up.Conclusions: Alcohol septal ablation is a promising option for the treatment of a selected population with hypertrophicobstructive cardiomyopathy, generating sustained clinical and functional improvement with low incidence of events in thelong-term follow up.
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Pedernera et al. (2015) conducted an observational in Obstructive hypertrophic cardiomyopathy refractory to optimal medical therapy (n=23). Percutaneous alcohol septal ablation was evaluated on Left ventricular outflow tract gradient (p=<0.003). Percutaneous alcohol septal ablation significantly reduced baseline left ventricular outflow tract gradient from 75 mmHg to 25 mmHg (P<0.003) and improved functional class.
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