Contemporary Results for Septal Embolization in Hypertrophic Cardiomyopathy

This work showed that percutaneous septal ablation in patients with symptomatic hypertrophic cardiomyopathy is safe (and improves patient symptoms) and results in excellent long-term survival.

Alcohol-induced infarction for treatment of symptomatic hypertrophic obstructive cardiomyopathy is controversial because, while it may relieve acute symptoms, it might also increase long-term mortality.

This study sought to report on long-term survival after this somewhat controversial (according to evidence available so far) procedure.

Between 2000 and 2017, septal ablation with alcohol was performed in 952 patients (mean age 55.7 ± 14.9 years; 59.2% men; 73.3% New York Heart Association functional class III or IV; 50.3% history of syncope; 10.3% history of sudden cardiac death in family).

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Clinical follow-up at 6.0 ± 5.0 years was achieved in all patients.

Patients were injected with 2.1 ± 0.4 cc of alcohol, which caused a maximal creatine kinase rise of 872 ± 489 U/l. Two (0.21%) patients died at 3 and 33 days after the procedure. One hundred (10.50%) patients required a permanent pacemaker.

Echocardiogram parameters were extremely significant; there were reductions from 63.9 ± 38.2 mmHg to 33.6 ± 29.8 mmHg at rest and from 104.6 ± 44.0 mmHg to 56.5 ± 41.0 mmHg at Valsalva (p < 0.0001, for both).

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During follow-up, 17.2% of patients underwent reablation as part of a planned staged procedure; 1.9% of patients ultimately underwent surgical septal myectomy, and 5.10% of patients required cardioverter-defibrillator implantation.

During follow-up, 70 patients died; however, causes of death were identified as non-cardiovascular in 50 of them.

Estimated 5-year survival was 95.8%; at 10 years, the survival rate was 88.3% and at 15 years, 79.7%. These are excellent figures and attest to procedural safety.

Conclusion

In this study, septal embolization with alcohol proved to be a safe procedure in patients with symptomatic hypertrophic cardiomyopathy and can be considered an alternative to surgical myectomy. The long-term survival rate was beyond satisfactory.

Original title: Survival After Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy.

Reference: Angelika Batzner et al. J Am Coll Cardiol 2018;72:3087-94.

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