Brazilian Multicenter Registry of Alcohol Septal Ablation for Patients with Symptomatic Hypertrophic Obstructive
Pedro Jallad1, Marilia Soliani2, Pedro Henrique Almeida Marins2
1Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.
Insights
Alcohol septal ablation (ASA) effectively treats symptomatic hypertrophic obstructive cardiomyopathy (HOCM) by reducing left ventricular outflow tract (LVOT) gradients and septal thickness. This safe procedure offers significant symptom relief for HOCM patients in Brazil.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Alcohol septal ablation (ASA) is an alternative to surgical myectomy for symptomatic hypertrophic obstructive cardiomyopathy (HOCM) with left ventricular outflow tract (LVOT) obstruction.
- Limited data exists on ASA outcomes specifically within Brazil.
Purpose of the Study:
- To evaluate the safety and effectiveness of ASA in Brazilian HOCM patients.
- Assess outcomes in patients receiving optimal medical therapy using current techniques.
Main Methods:
- Included HOCM patients with CCS/NYHA class >II unresponsive to optimal medical treatment.
- Primary efficacy endpoint: >50% reduction in maximum resting LVOT gradient to <50 mmHg.
- Classified patients as responders or nonresponders.
Main Results:
- 41 patients underwent ASA; 93.2% were NYHA/CCS class III/IV at baseline.
- After 12 months, 92.8% improved to NYHA/CCS class I/II (p<0.01).
- Mean LVOT gradient decreased from 88.4 mmHg to 27.0 mmHg (p=0.003); septal thickness reduced (p=0.048).
- Complete atrioventricular block occurred in 16.7%, with 4.8% requiring pacemakers; no deaths reported.
Conclusions:
- ASA is a safe and effective treatment for symptom relief in selected HOCM patients.
- The procedure effectively reduces LVOT gradient and interventricular septum thickness.
- Higher baseline LVOT gradients were associated with a lower likelihood of response.
Background:
Alcohol septal ablation (ASA) is an alternative to surgical myectomy for patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) and significant left ventricular (LV) outflow tract (LVOT) obstruction. Although widely studied worldwide, data on ASA outcomes in Brazil are still limited.
Objective:
To assess the safety and effectiveness of ASA in symptomatic HOCM patients receiving optimal medical therapy using current techniques across multiple centers in Brazil.
Methods:
Patients with HOCM and angina (classified by the Canadian Cardiovascular Society [CCS]) or dyspnea (classified by the New York Heart Association [NYHA]) class >II who did not respond to optimal medical treatment were included. The primary efficacy endpoint was defined as a reduction of more than 50% in the maximum resting LVOT gradient, with a final gradient <50 mmHg. Patients were classified as responders or nonresponders. A p-value <0.05 was considered statistically significant.
Results:
A total of 41 patients (median age 66.4 years; 73% female) underwent ASA. At baseline, 93.2% were in NYHA class III/IV or CCS class III/IV. The mean LV ejection fraction (LVEF) was 66.4%, and the mean LVOT gradient was 88.4 mmHg. After 12 months, 92.8% had improved to NYHA class I/II or CCS class I/II (p<0.01). The mean LVOT gradient dropped from 88.4 mmHg to 27.0 mmHg (p=0.003), and interventricular septum (IVS) thickness decreased from 19.3 mm to 14.7 mm (p=0.048). Responders had lower baseline gradients (73.4 vs 112.6 mmHg, p=0.04) and fewer hospitalizations (21.1% vs 82.4%, p=0.04). Complete atrioventricular block occurred in 16.7% of patients, and 4.8% required pacemakers. No deaths were reported during a median follow-up of 394 days. At the last in-person evaluation, 78.4% were in functional class I/II.
Conclusions:
ASA is a safe, effective option for relieving symptoms in selected HOCM patients. It reduces LVOT gradient and septal thickness. Patients with higher baseline gradients were less likely to respond to the procedure.
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