Outcomes of Alcohol Septal Ablation in Younger Patients With Obstructive Hypertrophic Cardiomyopathy

Abstract Objectives The aim of this study was to describe the safety and outcomes of alcohol septal ablation (ASA) in younger patients with obstructive hypertrophic cardiomyopathy. Background The American College of Cardiology Foundation/American Heart Association guidelines reserve ASA for older pa...

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Bibliographic Details
Published in:JACC. Cardiovascular interventions 2017-06, Vol.10 (11), p.1134-1143
Main Authors: Liebregts, Max, MD, Faber, Lothar, MD, Jensen, Morten K., MD, Vriesendorp, Pieter A., MD, PhD, Januska, Jaroslav, MD, Krejci, Jan, MD, PhD, Hansen, Peter R., MD, DMSc, PhD, Seggewiss, Hubert, MD, Horstkotte, Dieter, MD, Adlova, Radka, MD, Bundgaard, Henning, MD, DMSc, ten Berg, Jurriën M., MD, PhD, Veselka, Josef, MD, PhD
Format: Article
Language:English
Subjects:
Ablation Techniques - adverse effects
Ablation Techniques - mortality
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
alcohol septal ablation
Arrhythmias, Cardiac - etiology
Arrhythmias, Cardiac - therapy
Cardiac Pacing, Artificial
Cardiomyopathy, Hypertrophic - diagnostic imaging
Cardiomyopathy, Hypertrophic - mortality
Cardiomyopathy, Hypertrophic - surgery
Cardiovascular
Disease-Free Survival
Ethanol - adverse effects
Ethanol - therapeutic use
Europe
Female
Heart Septum - diagnostic imaging
Heart Septum - surgery
Humans
hypertrophic cardiomyopathy
Kaplan-Meier Estimate
Male
Middle Aged
Pacemaker, Artificial
Patient Selection
Retrospective Studies
Risk Assessment
Risk Factors
septal reduction therapy
Sex Factors
Time Factors
Treatment Outcome
Ventricular Outflow Obstruction - diagnostic imaging
Ventricular Outflow Obstruction - mortality
Ventricular Outflow Obstruction - surgery
Young Adult
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Summary:Abstract Objectives The aim of this study was to describe the safety and outcomes of alcohol septal ablation (ASA) in younger patients with obstructive hypertrophic cardiomyopathy. Background The American College of Cardiology Foundation/American Heart Association guidelines reserve ASA for older patients and patients with serious comorbidities. Data on long-term age-specific outcomes after ASA are scarce. Methods A total of 1,197 patients (mean age 58 ± 14 years) underwent ASA for obstructive hypertrophic cardiomyopathy. Patients were divided into young (≤50 years), middle-age (51 to 64 years), and older (≥65 years) groups. Results Thirty-day mortality and pacemaker implantation rates were lower in young compared with older patients (0.3% vs. 2% [p = 0.03] and 8% vs. 16% [p < 0.001], respectively). Ninety-five percent of young patients were in New York Heart Association functional class I or II at last follow-up. During a mean follow-up period of 5.4 ± 4.2 years, 165 patients (14%) died. Annual mortality rates of young, middle-age, and older patients were 1%, 2%, and 5%, respectively (p < 0.01). Annual adverse arrhythmic event rates were similar in the 3 age groups at about 1% (p = 0.90). Independent predictors of mortality in young patients were age, female sex, and residual left ventricular outflow tract gradient. Additionally, young patients treated with ≥2.5 ml alcohol had a higher all-cause mortality rate (0.6% vs. 1.4% per year in patients treated with 
ISSN:1936-8798
1876-7605
DOI:10.1016/j.jcin.2017.03.030