Comparable outcomes in single versus multiple septal branches alcohol ablation for obstructive hypertrophic
Josef Veselka1, Eva Hansvenclova2, Klara Hulikova Tesarkova3
1Department of Cardiology, Angiology and Intensive Care, Klinikum Chemnitz gGmbH, Medical Campus Chemnitz of the Technische Universität Dresden, Dresden, Germany.
Insights
For hypertrophic obstructive cardiomyopathy, alcohol septal ablation (ASA) targeting one or more septal branches is equally safe and effective. This study found no significant differences in short- or long-term outcomes between single and multiple septal branch ablations.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Alcohol septal ablation (ASA) is a treatment for hypertrophic obstructive cardiomyopathy (HOCM).
- The optimal number of septal branches to ablate remains debated.
- Uncertainty exists regarding ablating additional branches if the initial procedure is not fully effective.
Purpose of the Study:
- To compare the efficacy and safety of single versus multiple septal branch ablations in HOCM.
- To determine if ablating additional septal branches impacts patient outcomes.
- To provide evidence for procedural decision-making in ASA for HOCM.
Main Methods:
- Retrospective analysis of 457 patients undergoing ASA for HOCM.
- Propensity score matching to create comparable groups of single- versus multiple-ablated branches.
- Comparison of short-term (30-day) and long-term cardiovascular adverse events, mortality, re-intervention, and functional outcomes.
Main Results:
- 92 matched pairs (184 patients) were analyzed.
- No significant difference in major cardiovascular adverse events within 30 days between groups.
- Comparable long-term outcomes including all-cause mortality, re-intervention rates, left ventricular outflow tract gradient, and NYHA functional class between single and multiple ablations.
Conclusions:
- ASA targeting single or multiple septal branches demonstrates similar efficacy and safety.
- The number of septal branches ablated does not appear to significantly affect short- or long-term outcomes in HOCM patients.
- These findings support current practices and may guide future procedural strategies.
Background:
The optimal number of septal branches to target during initial alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) remains a subject of debate. It is unclear whether to proceed with ASA of additional septal branches if a satisfactory hemodynamic effect has not been achieved following ablation of the first branch.
Methods:
Using propensity score matching analysis, we compared patients who achieved satisfactory outcomes after ASA of a single septal branch with those in whom additional branches were ablated.
Results:
A total of 457 patients were included in the study, with a median follow-up of 5.61 years (interquartile range 2.08-10.91 years). Propensity score matching identified 92 pairs (184 patients), divided into the single-ablated-branch and more-ablated-branches groups. No significant differences were found in the incidence of major cardiovascular adverse events within the first 30 days between the two groups. Similarly, there were no differences in long-term outcomes between the matched single-ablated-branch and multiple-ablated-branches groups regarding all-cause mortality (3.77 vs.2.90 deaths per 100 patient-years, log-rank p = 0.649), re-intervention rates (12 % vs. 8 %; log-rank p = 0.345), left ventricular outflow gradient (14 ± 13 mmHg vs. 16 ± 15 mmHg; p = 0.209), or NYHA functional class (1.7 ± 0.6 vs. 1.6 ± 0.7; p = 0.629).
Conclusions:
In both short- and long-term follow-ups, ASA targeting single or multiple septal branches showed comparable efficacy and safety in patients with hypertrophic obstructive cardiomyopathy.
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