Survival After Alcohol Septal Ablation in Patients With Hypertrophic Obstructive Cardiomyopathy

• Published in: Journal of the American College of Cardiology 2018-12, Vol.72 (24), p.3087-3094
• Main Authors: Batzner, Angelika, Pfeiffer, Barbara, Neugebauer, Anna, Aicha, Diaa, Blank, Christoph, Seggewiss, Hubert
• Format: Article
• Language: English
• Subjects: Ablation; Ablation Techniques; Adult; Aged; Alcohol; alcohol ablation; Alcohols; Anaerobic threshold; Angina pectoris; Cardiac arrhythmia; cardiac mortality; Cardiology; Cardiomyopathy; Cardiomyopathy, Hypertrophic - mortality; Cardiomyopathy, Hypertrophic - therapy; Cardiovascular disease; Cardiovascular diseases; Catheters; Cerebral infarction; Cohort Studies; Coronary vessels; Creatine; Creatine kinase; Defibrillators; Dyspnea; Electrocardiography; Ethanol - therapeutic use; Female; Heart; Heart Septum; Hospitals; Humans; hypertrophic obstructive cardiomyopathy; Implantation; Infarction; Male; Medical prognosis; Mercury; Middle Aged; Mortality; Patients; Risk analysis; Risk factors; Solvents - therapeutic use; Stroke; sudden cardiac death; Surgery; Survival; Survival Rate; Syncope; Treatment Outcome
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2018.09.064

Alcohol-induced infarction for treatment of symptomatic hypertrophic obstructive cardiomyopathy (HOCM) was discussed as a risk factor for increased cardiac mortality during follow-up. This study sought to report on long-term survival after echo-guided alcohol septal ablation (percutaneous transluminal septal myocardial ablation [PTSMA]) in symptomatic patients with HOCM. Between May 2000 and June 2017, PTSMA with alcohol injection was performed in 952 patients (age 55.7 ± 14.9 years; 59.2% men; 73.3% New York Heart Association functional class III or IV; 50.3% syncope; 10.3% sudden cardiac death in family). Clinical follow-up after 6.0 ± 5.0 years was achieved in all patients. We injected 2.1 ± 0.4 cc of alcohol. Maximal creatine kinase rise was 872 ± 489 U/l. Two (0.21%) patients died 3 and 33 days after ablation. Permanent pacemaker was implanted in 100 (10.50%) patients. Echo gradients were acutely reduced from 63.9 ± 38.2 mm Hg to 33.6 ± 29.8 mm Hg at rest and from 104.6 ± 44.0 mm Hg to 56.5 ± 41.0 mm Hg at Valsalva (p < 0.0001, each). During follow-up, 164 (17.2%) patients underwent reablation due to the planned staged procedure, 18 (1.9%) patients underwent surgical myectomy, and 49 (5.10%) patients underwent cardioverter-defibrillator implantation. Seventy patients died: causes of death were identified as noncardiovascular in 50, stroke related in 6, and cardiac in 14 patients. Estimated 5-year survival was 95.8%, estimated 5-year survival free of cardiovascular events was 98.6%, and an estimated 5-year survival free of cardiac events was 98.9%. Corresponding values at 10 years were 88.3%, 96.5%, and 97.0%, and at 15 years were 79.7%, 92.3%, and 96.5%. In this study, PTSMA could be proofed as a safe procedure with ongoing symptomatic improvement and excellent long-term survival. Therefore, PTSMA is a reasonable alternative to surgical myectomy in HOCM. [Display omitted]