Alcohol septal ablation in hypertrophic cardiomyopathy utilizing a longitudinal 17-year study (mean 10.8). Observation follow-ups taken at a single medical centre
Abstract
Background: Alcohol septal ablation (ASA) is a method of treatment in obstructive hypertrophic cardiomyopathy (HOCM), but there is little data on the long-term results of ASA and the natural course after treatment. The aim of the study was to evaluate the results of ASA in HOCM in multiannual observation, and its impact on patient survival, exercise capacity, electrical complications, and changes in the anatomy and function of the heart. Methods: The study evaluated 47 patients with HOCM with a high left ventricular outflow tract (LVOT gradient) treated between 1997 and 2014 with ASA. Annual examinations evaluated the clinical condition, at rest and with exercise electrocardiogram, Holter monitoring, echocardiography, the evolution of HOCM towards the dilated form, and the frequency of pacemaker implantation.
Results: The analysis included data from 34 patients under observation for 3 to 17 (mean 10.8) years. Their age at procedure was 21–65, a mean of 47 years. All patients had permanently reduced LVOT gradient with a mean of 77.36 ± 35.46 to 11.40 ± 10.85 and showed improvement in the performance I to II New York Heart Association. Two out of five deaths had possible cardiac etiology. Fifteen patients received a pacemaker or cardioverter implants. In 4 subjects the long-term observation revealed new wall contractility abnormalities, interpreted as a shift of HOCM to the dilated form.
Conclusions: Alcohol septal ablation permanently eliminated the gradient in LVOT and improved the performance of patients, however it did not prevent a shift of HOCM to the dilated form. Pacemaker implantations are relatively frequent. (Cardiol J 2017; 24, 2: 125–130)
Keywords: alcohol septal ablationarrhythmias and conduction abnormalitiesheart failurehypertrophic obstructive cardiomyopathy
References
- Maron BJ, Gardin JM, Flack JM, et al. Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA Study. Coronary Artery Risk Development in (Young) Adults. Circulation. 1995; 92(4): 785–789.
- Richard P, Charron P, Carrier L, et al. EUROGENE Heart Failure Project. Hypertrophic cardiomyopathy: distribution of disease genes, spectrum of mutations, and implications for a molecular diagnosis strategy. Circulation. 2003; 107(17): 2227–2232.
- Melacini P, Basso C, Angelini A, et al. Clinicopathological profiles of progressive heart failure in hypertrophic cardiomyopathy. Eur Heart J. 2010; 31(17): 2111–2123.
- Harris KM, Spirito P, Maron MS, et al. Prevalence, clinical profile, and significance of left ventricular remodeling in the end-stage phase of hypertrophic cardiomyopathy. Circulation. 2006; 114(3): 216–225.
- Olivotto I, Montereggi A, Mazzuoli F, et al. Clinical utility and safety of exercise testing in patients with hypertrophic cardiomyopathy. G Ital Cardiol. 1999; 29(1): 11–19.
- Elliott PM, Anastasakis A, Borger MA, et al. Authors/Task Force members. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014; 35(39): 2733–2779.
- Kappenberger L, Linde C, Daubert C, et al. Pacing in hypertrophic obstructive cardiomyopathy. A randomized crossover study. PIC Study Group. Eur Heart J. 1997; 18(8): 1249–1256.
- Wigle ED, Chrysohou A, Bigelow WG. Results of ventriculomyotomy in muscular subaortic stenosis. Am J Cardiol. 1963; 11: 572–586.
- Sigwart U. Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy. Lancet. 1995; 346(8969): 211–214.
- Kornacewicz-Jach Z, Gil R, Wojtarowicz A, et al. Alkoholowa ablacja tętnicy septalnej w kardiomiopatii przerostowej z zawężaniem drogi odpływu. Wyniki wczesne. Kardiol Pol. 1998; 48: 105–112.
- Elliott P, Gimeno J, Tomé M, et al. Left ventricular outflow tract obstruction and sudden death in hypertrophic cardiomyopathy. Eur Heart J. 2006; 27(24): 3073; author reply 3073–4.
- Maron BJ, Olivotto I, Spirito P, et al. Epidemiology of hypertrophic cardiomyopathy-related death: revisited in a large non-referral-based patient population. Circulation. 2000; 102(8): 858–864.
- O'Mahony C, Tome-Esteban M, Lambiase PD, et al. A validation study of the 2003 American College of Cardiology/European Society of Cardiology and 2011 American College of Cardiology Foundation/American Heart Association risk stratification and treatment algorithms for sudden cardiac death in patients with hypertrophic cardiomyopathy. Heart. 2013; 99(8): 534–541.
- Olivotto I, Cecchi F, Poggesi C, et al. Patterns of disease progression in hypertrophic cardiomyopathy: an individualized approach to clinical staging. Circ Heart Fail. 2012; 5(4): 535–546.
- Jensen MK, Prinz C, Horstkotte D, et al. Alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy: low incidence of sudden cardiac death and reduced risk profile. Heart. 2013; 99(14): 1012–1017.
- Ommen SR, Maron BJ, Olivotto I. Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol. 2005; 46: 470–476.
- Faber L, Seggewiss H, Gleichmann U. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: results with respect to intraprocedural myocardial contrast echocardiography. Circulation. 1998; 98(22): 2415–2421.
- Agarwal S, Tuzcu EM, Desai MY, et al. Updated meta-analysis of septal alcohol ablation versus myectomy for hypertrophic cardiomyopathy. J Am Coll Cardiol. 2010; 55(8): 823–834.
- Alam M, Dokainish H, Lakkis NM. Hypertrophic obstructive cardiomyopathy-alcohol septal ablation vs. myectomy: a meta-analysis. Eur Heart J. 2009; 30(9): 1080–1087.
- Liebregts M, Vriesendorp PA, Mahmoodi BK, et al. A Systematic Review and Meta-Analysis of Long-Term Outcomes After Septal Reduction Therapy in Patients With Hypertrophic Cardiomyopathy. JACC Heart Fail. 2015; 3(11): 896–905.
- Fernandes VL, Nielsen C, Nagueh SF, et al. Follow-up of alcohol septal ablation for symptomatic hypertrophic obstructive cardiomyopathy the Baylor and Medical University of South Carolina experience 1996 to 2007. JACC Cardiovasc Interv. 2008; 1(5): 561–570.
- Kuhn H, Lawrenz T, Lieder F, et al. Survival after transcoronary ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy (TASH): a 10 year experience. Clin Res Cardiol. 2008; 97(4): 234–243.
- Welge D, Seggewiss H, Fassbender D, et al. Long-term follow-up after percutaneous septal ablation in hypertrophic obstructive cardiomyopathy. Deutsche Medizinische Wochenschrift. 2008; 133: 1949–1954.
- Maron B, Spirito P, Shen WK, et al. Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy. JAMA. 2007; 298(4): 405–412.
