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[Long-term follow-up after percutaneous septal ablation in hypertrophic obstructive cardiomyopathy ]
D Welge1, H Seggewiss, D Fassbender
1Kardiologische Klinik, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen.
Insights
Percutaneous septal ablation effectively relieves symptoms and obstruction in hypertrophic obstructive cardiomyopathy (HOCM) patients. This interventional therapy shows sustained benefits without increasing mortality, though long-term monitoring is essential.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) significantly impacts patient quality of life.
- Optimal medical treatment often fails to fully resolve symptoms in HOCM patients with significant outflow tract obstruction.
- Surgical and interventional therapies are considered for obstruction relief, with limited long-term data on percutaneous septal ablation.
Purpose of the Study:
- To evaluate the long-term outcomes of percutaneous transluminal septal myocardial ablation (PTSMA) in a large cohort of HOCM patients.
- To assess the efficacy and safety of PTSMA in relieving outflow tract obstruction and improving symptoms.
- To analyze mortality, morbidity, and clinical/echocardiographic parameters post-procedure.
Main Methods:
- 347 patients with HOCM (NYHA class II-IV) underwent PTSMA.
- Follow-up included clinical assessment, exercise testing, and echocardiography.
- Mortality, morbidity, and procedural success rates were systematically recorded over an average of 58 months.
Main Results:
- Overall mortality was 1.8% per year, with cardiovascular mortality at 1% per year.
- 89% of patients improved to NYHA class I or II post-procedure.
- Significant reduction in resting (74%) and provokable (60%) obstruction was observed, with 8% requiring a second procedure. 12% experienced supraventricular arrhythmias.
Conclusions:
- PTSMA offers significant, sustained symptom and echocardiographic improvement in HOCM patients.
- The procedure demonstrates a favorable safety profile with no excess mortality.
- Long-term surveillance is crucial due to the persistence of underlying structural heart disease and potential for arrhythmias.
Background And Objective:
Persisting disabling symptoms despite optimal medical treatment in patients with hypertrophic cardiomyopathy and significant outflow tract obstruction prompt surgical or interventional therapy targeted at relief of obstruction. While surgical treatment was introduced more than 40 years ago, there are only a few data on the long-term results of percutaneous septal ablation. This study gives the results of a large number of patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent septal ablation in our institution.
Patients And Methods:
347 patients (156 females, 191 males, 54 +/- 15 years) in NYHA functional class III or IV, or in class II but with evidence of more severe limitation on exercise testing, underwent percutaneous transluminal septal myocardial ablation (PTSMA). Mortality and morbidity, as well as clinical and echocardiographic parameters were assessed during follow-up, either at our institution, or by the referring cardiologist.
Results:
During an average follow-up of 58 +/- 35 months the overall mortality was about 1,8 % per year, with a cardiovascular-related mortality of about 1 % per year. 8 % of patients needed a second procedure. A significant and sustained improvement of symptoms (89 % patients were in NYHA class I or II a follow-up) and obstruction were demonstrated (74 % of patients were free from obstruction at rest, 60 % did not exhibit provokable gradients). Supraventricular arrhythmias, especially atrial fibrillation, were observed in 12 % of patients.
Conclusion:
Percutaneous septal ablation provides significant and sustained beneficial effects on symptoms and echocardiographic variables, without evidence of an excess mortality. But independently of the clinical success of the procedure persistence of the underlying structural heart disease should be kept in mind. Periodic re-evaluation is mandatory to identify and treat high-risk patients.
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