Alcohol septal ablation for symptomatic HOCM significantly decreased resting LVOT gradient from 74 to 4 mmHg (p<0.01) and improved NYHA class over a mean follow-up of 3.6 years.
Cohort (n=130)
No
Does alcohol septal ablation improve symptoms, exercise capacity, and LVOT gradients in patients with symptomatic hypertrophic obstructive cardiomyopathy?
Alcohol septal ablation is an effective procedure for symptomatic HOCM, significantly reducing symptoms, improving exercise performance, and decreasing LVOT gradients over a mean follow-up of 3.6 years.
Absolute Event Rate: 4% vs 74%
p-value: p=< 0.01
BACKGROUND: There is a paucity of data on the long-term outcome of alcohol septal ablation (ASA) for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). HYPOTHESIS: The study was undertaken to evaluate the longer-term outcome of ASA therapy for symptomatic HOCM. METHODS: In all, 137 patients were enrolled consecutively (1996-1999) and 130 (95%) (74 men, 56 women, aged 51 +/- 17 years) underwent ASA and had serial prospective follow-up for up to 5 years (mean follow-up 3.6 +/- 1.4 years). Evaluation included angina (Canadian Cardiovascular Society CCS score), dyspnea (New York Heart Association NYHA class), duration of exercise on treadmill, and echocardiographic indices. RESULTS: Ethanol (3.5 +/- 1.5 cc), injected into 1.5 +/- 0.6 arteries, induced a mean peak plasma creatine kinase (CK) of 1676 +/- 944 units. Complications of procedures included death 1.5% (2/130), heart block requiring permanent pacemaker 13% (17/130), and coronary dissection 4.4% (6/130). Baseline versus last follow-up visit: NYHA class decreased from 3.0 +/- 0.4 to 1.2 +/- 0.6 (p < 0.01); CCS angina score from 2.0 +/- 0.8 to 0.08 +/- 0.4 (p < 0.01); and duration of exercise increased from 322 +/- 207 to 443 +/- 200 s (p < 0.01). Resting left ventricular outflow tract gradient at baseline versus last follow-up visit showed a decrease from 74 +/- 30 to 4 +/- 13 (p < 0.01), and the dobutamine-provoked gradient of 88 +/- 29 decreased to 21 +/- 21 (p < 0.01) mmHg. All-cause mortality over the duration of follow-up was 7.7% (10) giving an annual rate of 2.1%, and cardiac mortality was 2.3% (3) reflecting an annual rate of 0.6%. CONCLUSIONS: Alcohol septal ablation decreased symptoms and improved exercise performance, indicating that it is an effective procedure for symptomatic HOCM.
Fernandes et al. (2005) conducted a cohort in Symptomatic hypertrophic obstructive cardiomyopathy (HOCM) (n=130). Alcohol septal ablation (ASA) vs. Baseline was evaluated on Resting left ventricular outflow tract gradient (mmHg) (p=< 0.01). Alcohol septal ablation for symptomatic HOCM significantly decreased resting LVOT gradient from 74 to 4 mmHg (p<0.01) and improved NYHA class over a mean follow-up of 3.6 years.