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Outcomes and Sex Differences in Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy-Insights from a

Tetsuo Yamaguchi1, Mitsuyoshi Takahara2, Shun Kohsaka3

  • 1Department of Cardiovascular Center, Toranomon Hospital, Tokyo, Japan.

The American Journal of Cardiology
|March 7, 2026
PubMed

Insights

Alcohol septal ablation (ASA) effectively reduces left ventricular outflow tract gradients in obstructive hypertrophic cardiomyopathy (HOCM) patients in Japan. While safe, female sex is linked to higher risks of heart block requiring pacemakers.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Imaging

Background:

  • Obstructive hypertrophic cardiomyopathy (HOCM) significantly impacts patient quality of life.
  • Alcohol septal ablation (ASA) is an established treatment for symptomatic HOCM.
  • Limited data exist on current ASA practices and outcomes specifically within Japan.

Purpose of the Study:

  • To evaluate the current practice and in-hospital outcomes of ASA in Japan.
  • To identify predictors of procedural success and complications following ASA.
  • To assess the safety and efficacy of ASA for HOCM patients in a Japanese nationwide registry.

Main Methods:

  • Analysis of data from 634 patients who underwent ASA between January 2019 and December 2022.
  • Data extracted from the nationwide prospective J-SHD registry.
  • Multivariate logistic regression used to identify predictors of success and complications.

Main Results:

  • Successful alcohol injection in 99.6% of cases, significantly reducing LVOT gradient (72.0 to 20.9 mmHg).
  • Low in-hospital mortality (0.16%) and low rates of ventricular arrhythmia (0.63%).
  • High-grade heart block requiring permanent pacemaker implantation occurred in 7.9% of patients; female sex predicted this complication.

Conclusions:

  • Alcohol septal ablation is a safe and effective therapy for symptomatic obstructive hypertrophic cardiomyopathy in Japan.
  • Higher pre-procedural LVOT gradient predicts successful gradient reduction.
  • Female sex is an independent predictor of high-grade heart block requiring pacemaker implantation.

Keywords:
alcohol septal ablationhypertrophic obstructive cardiomyopathyin-hospital outcomes

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