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Procedural complication and long term outcomes after alcohol septal ablation in patients with obstructive
Shuo-Yan An1, Yin-Jian Yang1, Fei Hang1
1Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HOCM) shows low periprocedural risks and excellent long-term survival comparable to non-obstructive hypertrophic cardiomyopathy (NOHCM). Patients under 40 require caution due to higher arrhythmia risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Hypertrophic Cardiomyopathy Research
Background:
- Limited data exists on procedural complications and long-term survival of alcohol septal ablation (ASA) in Chinese patients with obstructive hypertrophic cardiomyopathy (HOCM).
- Obstructive hypertrophic cardiomyopathy (HOCM) poses significant risks, necessitating effective treatment strategies.
- Non-obstructive hypertrophic cardiomyopathy (NOHCM) serves as a relevant comparison group for survival outcomes.
Purpose of the Study:
- To investigate the long-term survival of Chinese patients with obstructive hypertrophic cardiomyopathy (HOCM) following alcohol septal ablation (ASA).
- To compare the long-term survival rates of HOCM patients treated with ASA against a control group of non-obstructive hypertrophic cardiomyopathy (NOHCM) patients.
- To identify predictors of periprocedural lethal ventricular arrhythmia in patients undergoing ASA.
Main Methods:
- A cohort of 233 obstructive hypertrophic cardiomyopathy (HOCM) patients (peak gradient ≥50 mmHg) treated with ASA between 2000-2012 at Fuwai Hospital, China.
- A control group of 297 non-obstructive hypertrophic cardiomyopathy (NOHCM) patients without left ventricular outflow tract obstruction.
- Analysis of periprocedural mortality, complications, and 10-year overall survival rates, with logistic regression for predictor identification.
Main Results:
- Periprocedural mortality for ASA was low at 0.89%, with lethal ventricular arrhythmia occurring in 4.0% of patients.
- Independent predictors for periprocedural lethal ventricular arrhythmia included higher alcohol volume (RR 1.44) and age ≤40 years (RR 4.63).
- The 10-year overall survival was high and comparable between the ASA-treated HOCM group (94.6%) and the NOHCM control group (92.9%), with no statistically significant difference (P=0.930).
Conclusions:
- Alcohol septal ablation (ASA) is associated with rare periprocedural mortality and complications in obstructive hypertrophic cardiomyopathy (HOCM) patients.
- Long-term survival following ASA is satisfactory and comparable to non-obstructive hypertrophic cardiomyopathy (NOHCM).
- Patients under 40 undergoing ASA require heightened vigilance due to an increased risk of periprocedural lethal ventricular arrhythmia.
Abstract:
Data on procedural complications and long term survival after alcohol septal ablation (ASA) in Chinese patients with obstructive hypertrophic cardiomyopathy (HOCM) are lacking. We aimed to investigate long-term survival of HOCM patients after ASA and compared to the non-obstructive hypertrophic cardiomyopathy(NOHCM). A total of 233 patients with HOCM and a peak pressure gradient of ≥50 mm Hg at rest or with provocation were consecutively enrolled from Fuwai Hospital in China between 2000 and 2012. Another 297 patients without left ventricular outflow tract obstruction were regarded as control group. Periprocedural mortality of ASA were low (0.89%). Periprocedural lethal ventricular arrhythmia occurred in 9 patients (4.0%). Alcohol volume (RR 1.44, 95% CI: 1.03-2.03, P = 0.034) and age ≤40 years old (RR 4.63, 95% CI: 1.07-20.0, P = 0.040) were independent predictors for periprocedural lethal ventricular arrhythmia. The 10- year overall survival was 94.6% in the ASA group, similar with 92.9% in the NOHCM group (P = 0.930). In conclusion, periprocedural mortality and complications were rare in ASA. Long term survival after ASA were satisfactory and comparable to NOHCM. Patients under 40 years old should be more cautious undergoing ASA, for these patients were more likely to endure lethal ventricular arrhythmia during periprocedural period of ASA.
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