Survival After Alcohol Ablation in HOCM Patients

Study Questions:

What is the long-term survival after echo-guided alcohol septal ablation (percutaneous transluminal septal myocardial ablation [PTSMA]) in symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM)?

Methods:

The authors reported on their single-center clinical experience with PTSMA. Over the study period of May 2000 to June 2017, they performed PTSMA with alcohol injection in 952 patients. Complete clinical follow-up was obtained in all patients at 6.0 ± 5.0 years.

Results:

The average age of the cohort was 55.7 ± 14.9 years; 60% were men and the majority (73%) were New York Heart Association functional class III or IV. The volume of alcohol injected was 2.1 ± 0.4 cc of alcohol. Two (0.21%) patients died 3 and 33 days after ablation. A permanent pacemaker was implanted in 100 (10.50%) patients. Echo gradients were acutely reduced from 64 mm Hg to 34 mm Hg at rest, and from 105 mm Hg to 57 mm Hg with Valsalva. Planned staged re-ablation was performed in 164 (17.2%) patients, while 18 (1.9%) patients underwent surgical myectomy. There were 70 deaths on follow-up with 50 of the deaths being identified as noncardiovascular, related to stroke in six, and cardiac in 14 patietnts. Estimated 5-year survival was 95.8%, with a 5-year survival free of cardiovascular events of 98.6%.

Conclusions:

PTSMA for treatment of symptomatic HOCM is a safe procedure with excellent long-term survival.

Perspective:

The work in this paper represents the outcome of patients treated at a highly experienced center by a team that pioneered this procedure. The excellent safety and long-term outcome observed in this cohort matches that seen with surgical therapy and suggests that in experienced centers, alcohol ablation could be considered a reasonable alternative therapy for symptomatic patients with HOCM. The outcome at less experienced centers is unlikely to match what is reported in this study and the definitive treatment of HOCM is best performed at centers with multidisciplinary experience in treatment of these complex patients.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound

Keywords: Ablation Techniques, Cardiac Surgical Procedures, Cardiology Interventions, Cardiomyopathy, Hypertrophic, Echocardiography, Heart Failure, Outcome Assessment (Health Care), Pacemaker, Artificial, Stroke, Survival


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