Original title: Survival of Patients ≤50 Years Alter Alcohol Septal Ablation for Hypertrofic Obstructive Cardiomyopathy. Reference: Josef Veselka, et al. Canadian Journal of Cardiology 2014,30:634-638
Treatment of symptomatic obstructive hypertrophic cardiomyopathy (HCM) is the surgical septal myomectomy nevertheless, currently arose several studies reporting a favourable evolution and comparable to surgery with septal ablation (AS). 75 patients under 50 years of age with HCM, 85 procedures were performed. The primary endpoint was all-cause mortality, and the secondary was all-cause mortality or defibrillator implant.
Average age of the population was 42 ± 7 years all symptomatic with a gradient of 73 ± 38 mmHg and the basal septum thickness of 23 ± 6 mm. Post procedure, 8% had complete AV block and 2.7% transient AV block with a need for permanent pacemaker of 6.7%. Follow-up was performed in all patients at 5.1 years showing significant improvement in functional class associated with a fall in the gradient outflow tract and decreased thickness in the basal septum.
Four patients died during follow-up (1 to 30 days by sudden death, 1 by stroke, 1 from gastrointestinal bleeding and 1 for cancer), only two were attributed to the underlying disease. Survival rates at 1, 3 and 5 years were 97%, 94%, and 94%, respectively, not being able to identify predictors of mortality in the multivariate analysis. The risk of death or need for a defibrillator was not associated with post septal ablation gradient.
Conclusion:
This study in patients with obstructive hypertrophic cardiomyopathy (HCM) under 50 years who received septal ablation suggests a low risk of death from any cause or defibrillator implant in the long-term monitoring.
Editorial comment
Myomectomy remains the best strategy for those patients who are operated; however, this study showed a favourable evolution and comparable to surgery in young people; septal ablation is a less aggressive behaviour. More research is needed.
Courtesy Dr. Carlos Fava
Interventional cardiologist
Favaloro Foundation
Argentina
Dr. Carlos Fava para SOLACI.ORG