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Alcohol septal ablation in patients aged 75 years or older with hypertrophic obstructive cardiomyopathy

Dennis Lawin1, Christoph Stellbrink2, Ekaterina Stellbrink2

  • 1Department of Cardiology and Intensive Care Medicine, University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Bielefeld, Germany dennis.lawin@klinikumbielefeld.de.

Heart (British Cardiac Society)
|July 17, 2023
PubMed

Insights

Alcohol septal ablation (ASA) is effective for older patients with hypertrophic obstructive cardiomyopathy (HOCM). While efficacy and mortality are similar to younger patients, elderly individuals have higher rates of AV block requiring pacemakers.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Medicine

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) can significantly impact quality of life.
  • Alcohol septal ablation (ASA) is a treatment option for HOCM, but data for elderly patients (≥75 years) are limited.

Purpose of the Study:

  • To evaluate the outcomes of ASA in patients aged 75 years and older with HOCM.
  • To compare the efficacy and safety of ASA in elderly patients versus younger patients.

Main Methods:

  • Retrospective analysis of consecutive ASA procedures performed between September 1997 and July 2021.
  • Inclusion criteria: HOCM with left ventricular outflow tract gradients (LVOTG) ≥50 mm Hg.
  • Comparison of echocardiographic, procedural, and clinical parameters between patients ≥75 years and <75 years at baseline and 6-month follow-up.

Main Results:

  • 208 ASAs were performed in patients ≥75 years and 1430 in patients <75 years.
  • Patients ≥75 years showed lower baseline 6-minute walk test distances (317.0 m vs 438.0 m).
  • Follow-up LVOTG was lower in the elderly group (29.5 mm Hg vs 39.5 mm Hg), but high-degree AV block rates were higher (25.5% vs 13.6%). In-hospital mortality was similar (1.0% vs 0.6%).

Conclusions:

  • ASA demonstrates comparable efficacy and in-hospital mortality for elderly patients (≥75 years) with HOCM compared to younger individuals.
  • Elderly patients undergoing ASA have an increased risk of high-degree atrioventricular block requiring permanent pacemaker implantation.
Abstract

Keywords:
cardiomyopathy, hypertrophic

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