Multiple-Branch Alcohol Septal Ablation Is Associated with Reduced Cardiovascular Events: Insights from a
Keitaro Akita1,2, Ryota Sato2, Atsushi Anzai3
1Division of Cardiology, Department of Medicine, Columbia University Irving Medical Centre, New York, New York, USA.
CJC Open
|November 3, 2025
Summary
Alcohol septal ablation (ASA) using multiple septal branches may reduce cardiovascular events in obstructive hypertrophic cardiomyopathy patients. This approach, particularly effective in reducing heart failure hospitalizations, offers a promising treatment option.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Alcohol septal ablation (ASA) is a key treatment for drug-refractory obstructive hypertrophic cardiomyopathy.
- The prognostic impact of multiple-branch ablation in ASA remains under investigation.
- Residual pressure gradients may necessitate multi-branch ablation in some patients.
Purpose of the Study:
- To evaluate the association between multiple-branch ASA and cardiovascular (CV) events.
- To compare CV event rates in single-branch versus multiple-branch ablation groups.
- To assess the efficacy of multi-branch ASA in managing obstructive hypertrophic cardiomyopathy.
Main Methods:
- A multicenter trans-Pacific study included 151 patients undergoing ASA.
- Patients were stratified into single-branch (n=66) and multiple-branch (n=85) ablation groups.
- Inverse probability of treatment weighting (IPTW) was used to adjust for confounding factors.
Main Results:
- Multiple-branch ablation was associated with significantly lower CV events (OR 0.27, P=0.01) post-IPTW.
- The reduction in CV events was primarily driven by decreased heart failure hospitalizations.
- Initial higher peak gradients in the multiple-branch group were comparable post-ablation.
Conclusions:
- ASA involving multiple septal branches may be an effective strategy for reducing CV events.
- This approach is suitable for morphologically and hemodynamically selected patients.
- Multi-branch ablation shows potential for improved outcomes in obstructive hypertrophic cardiomyopathy.
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