Alcohol septal ablation in patients with refractory HOCM resulted in a 12.5% long-term mortality rate and significant reductions in left ventricle outflow tract gradient (P<0.001).
Cohort (n=56)
Does percutaneous alcohol septal ablation improve survival and quality of life in patients with symptomatic refractory hypertrophic obstructive cardiomyopathy?
Alcohol septal ablation provides sustained long-term improvements in quality of life and LVOT gradients with low mortality and low immediate pacemaker requirement in patients with refractory HOCM.
BACKGROUND: Alcohol septal ablation (ASA) is an alternative treatment for symptomatic hypertrophic obstructive cardiomyopathy (HOCM) patients refractory to pharmacological therapy. We sought to evaluate the immediate and long-term incidence of death and changes in life quality in a consecutive cohort submitted to ASA. METHODS AND RESULTS: Between October 1998 and December 2013, a total of 56 patients (mean age 53.2 ± 15.5) with symptomatic refractory HOCM were treated with ASA and followed during 15 years (mean 8 ± 4 years). There were 7 (12.5%) deaths, 2 (3.6%) being of cardiac cause. The Kaplan-Meier survival probability estimate was 96.4% at 1 year, 87.7 at 5 years and 81.0% at 12 years post-ASA. Significant improvement was observed in life quality assessed by DASI index and NYHA functional class as well as in the left ventricle outflow tract (LVOT) gradient reduction (from 92.8 ± 3.3 mm Hg to 9.37 ± 6.7 mm Hg, P < 0.001) and septum thickness (from 23.9 ± 0.6 mm to 12.9 ± 1.0 mm, P < 0.001). Only one patient (1.7%) required permanent pacemaker immediately after ASA. During follow-up, one patient had a repeated ASA, three patients underwent myectomy and other four required ICD/pacemaker. In the multivariate model only post-ASA LVOT residual gradient and left ventricle mass were associated with worse prognosis. CONCLUSIONS: In this long-term clinical follow-up without losses, ASA was effective in improving quality of life and NYHA functional class, with relatively low mortality and very low need for immediate permanent pacemaker implantation. © 2016 Wiley Periodicals, Inc.
Cano et al. (Tue,) conducted a cohort in symptomatic refractory hypertrophic obstructive cardiomyopathy (HOCM) (n=56). Alcohol septal ablation (ASA) was evaluated on immediate and long-term incidence of death. Alcohol septal ablation in patients with refractory HOCM resulted in a 12.5% long-term mortality rate and significant reductions in left ventricle outflow tract gradient (P<0.001).