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).

Read also: Left Main PCI Technique Could Change DAPT Duration.

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).

Read also: Is Individual Operator Experience Important in TAVR?

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.

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.