Outcome of alcohol septal ablation for obstructive hypertrophic cardiomyopathy
Paul Sorajja1, Uma Valeti, Rick A Nishimura
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. paul.sorajja@mayo.edu
Insights
Alcohol septal ablation effectively treats obstructive hypertrophic cardiomyopathy symptoms in experienced centers, though complication rates are higher than myectomy. Younger patients may benefit more from myectomy for symptom resolution.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- The clinical effectiveness of alcohol septal ablation for drug-refractory hypertrophic cardiomyopathy is not well-established.
- This study evaluates outcomes of alcohol septal ablation at a specialized hypertrophic cardiomyopathy center.
Purpose of the Study:
- To assess the efficacy and safety of alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy.
- To compare outcomes with septal myectomy.
Main Methods:
- Retrospective analysis of 138 patients undergoing alcohol septal ablation (1998-2006).
- Comparison with age- and gender-matched patients who underwent septal myectomy.
- Evaluation of procedural complications, mortality, and symptom resolution.
Main Results:
- Alcohol septal ablation had higher complication rates (1.4% death, 20% pacemaker) than myectomy (5%).
- Four-year survival free of mortality was 88.0%, similar to myectomy.
- 51% of patients became asymptomatic, but myectomy offered better symptom resolution for patients <=65 years.
Conclusions:
- Alcohol septal ablation is effective for symptom relief in obstructive hypertrophic cardiomyopathy when performed at experienced centers.
- Procedural complication rates for ablation exceed those of myectomy.
- Myectomy may be superior for symptom resolution in younger patients (<=65 years).
Background:
The clinical efficacy of alcohol septal ablation for drug-refractory hypertrophic cardiomyopathy remains unclear. This study examines the outcome of alcohol septal ablation performed at a tertiary hypertrophic cardiomyopathy referral center.
Methods And Results:
Among 601 patients with severely symptomatic obstructive hypertrophic cardiomyopathy referred for alcohol septal ablation or myectomy from 1998 to 2006, 138 patients (median age, 64 years; 39% men) chose to undergo ablation. Procedural complications included death in 1.4%, sustained ventricular arrhythmias in 3%, tamponade in 3%, and pacemaker implantation in 20%. This rate was higher than a combined complication rate of 5% in age- and gender-matched patients who had undergone septal myectomy at Mayo Clinic (P<0.0001). Four-year survival free of all mortality was 88.0% (95% confidence interval, 79.4 to 97.5%), which was similar to that of the age- and gender-matched patients who had undergone myectomy (P=0.18). Six patients had documented ventricular arrhythmias after ablation, 4 of whom had successful intervention. Four-year survival free of death and severe New York Heart Association class III/IV symptoms after septal ablation was 76.4%, and 71 patients (51%) became asymptomatic. Myectomy patients
Conclusions:
Alcohol septal ablation is an efficacious procedure if performed in an experienced institution and may resolve symptoms in a subset of patients with obstructive hypertrophic cardiomyopathy. However, the procedural complication rate exceeds that of myectomy. Patients 65 years of age have better symptom resolution with myectomy. No impairment in short-term survival was noted in this nonrandomized study, but the long-term outcome remains unknown.
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