Age-related survival after alcohol septal ablation in hypertrophic obstructive cardiomyopathy

Since its introduction, alcohol septal ablation (PTSMA) was discussed as treatment option only in elderly symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). We report on long-term follow-up after PTSMA with respect to patient's age.

Between May 2000 and June 2017, we treated 952 consecutive HOCM patients with PTSMA; 133 (14.0%) patients were <40 years of age (Group A; mean age 30.3 ± 7.6; 26.3% female), 422 (44.3%) patients were between ≥40 and <60 years of age (Group B; mean age 50.6 ± 5.8; 27.0% female), and 397 (41.7%) patients were ≥60 years of age (Group C; 69.7 ± 6.1; 60.2% female). After PTSMA, need of pacemaker implantation was lowest in Group A (3.8%, P < 0.01 each) compared with Group B (9.2%) and Group C (14.1%) during hospital stay. One patient in Groups A and C died during hospital stay, each. Follow-up was longer in Group A (7.4 ± 5.5 years) compared with Group C (5.6 ± 4.8 years; P < 0.001) and comparable with Group B (6.5 ± 5.1 years). Mortality was highest in Group C (13.1%; P < 0.0001 each) compared with Group A (1.5%) and Group B (4.3%). In Group A, no patient died from cardiac reason, whereas five patients died from cardiac reasons in Group B and seven patients in Group C. Sudden cardiac death was not observed in Group A, whereas three patients in Group B and one patient in Group C suffered sudden cardiac death.

Mortality after PTSMA is predominantly due to non-cardiac reasons and mainly observed in elderly patients. Survival in young patients is not affected by cardiac mortality. In experienced centres with careful patient selection, PTSMA is safe in young patients.