Alcohol septal ablation for the treatment of hypertrophic obstructive cardiomyopathy. A multicenter North American registry. Academic Article uri icon

Overview

abstract

  • OBJECTIVES: The purpose of the study is to identify the predictors of clinical outcome (mortality and survival without repeat septal reduction procedures) of alcohol septal ablation for the treatment of patients with hypertrophic obstructive cardiomyopathy. BACKGROUND: Alcohol septal ablation is used for treatment of medically refractory hypertrophic obstructive cardiomyopathy patients with severe outflow tract obstruction. The existing literature is limited to single-center results, and predictors of clinical outcome after ablation have not been determined. Registry results can add important data. METHODS: Hypertrophic obstructive cardiomyopathy patients (N = 874) who underwent alcohol septal ablation were enrolled. The majority (64%) had severe obstruction at rest, and the remaining had provocable obstruction. Before ablation, patients had severe dyspnea (New York Heart Association [NYHA] functional class III or IV: 78%) and/or severe angina (Canadian Cardiovascular Society angina class III or IV: 43%). RESULTS: Significant improvement (p < 0.01) occurred after ablation (~5% in NYHA functional classes III and IV, and 8 patients in Canadian Cardiovascular Society angina class III). There were 81 deaths, and survival estimates at 1, 5, and 9 years were 97%, 86%, and 74%, respectively. Left anterior descending artery dissections occurred in 8 patients and arrhythmias in 133 patients. A lower ejection fraction at baseline, a smaller number of septal arteries injected with ethanol, a larger number of ablation procedures per patient, a higher septal thickness post-ablation, and the use beta-blockers post-ablation predicted mortality. CONCLUSIONS: Variables that predict mortality after ablation, include baseline ejection fraction and NYHA functional class, the number of septal arteries injected with ethanol, post-ablation septal thickness, beta-blocker use, and the number of ablation procedures.

authors

  • Nagueh, Sherif F.
  • Groves, Bertron M
  • Schwartz, Leonard
  • Smith, Karen M
  • Wang, Andrew
  • Bach, Richard G
  • Nielsen, Christopher
  • Leya, Ferdinand
  • Buergler, John M.
  • Rowe, Steven K
  • Woo, Anna
  • Maldonado, Yolanda Munoz
  • Spencer, William H

publication date

  • November 22, 2011

Research

keywords

  • Ablation Techniques
  • Cardiomyopathy, Hypertrophic
  • Ethanol
  • Ventricular Outflow Obstruction

Identity

Scopus Document Identifier

  • 81255166941

Digital Object Identifier (DOI)

  • 10.1016/j.jacc.2011.06.073

PubMed ID

  • 22093510

Additional Document Info

volume

  • 58

issue

  • 22