Author + information
- Maxim Kashtanov and
- Anastasiya Rzhannikova
Long-term outcomes of alcohol septal ablation (ASA) in patients with obstructive hypertrophic cardiomyopathy are still lacking. To assess long-term results, we followed 42 patients over 10 years.
ASAs were done for 160 unselected (all-comers) obstructive HCM patients between 2000 and 2017. In this historical cohort 42/160 patients (29 males and 13 females) were followed over 10 years (they were operated between 2000 and 2008). Mean period of follow-up was 12(2) years in this subgroup. Mean age at the time of the procedure was 44,2 (12,9). Risk factors at the baseline were syncopes (4 patients), smoking (4 patients), family history of HCM (3 patients), over 30 mm septum thickness (11 patients), sustain ventricular tachicardia (1 patient). Mean NYHA class was 2,5 (0.8). The similar ethanol dose (3.0 ml) was used in all cases. Repeat ASAs were done in 9 patients. 1 patient underwent the radio-frequency left ventricular outflow tract (LVOT)ablation at the long-term. Data were collected using local database, direct calls to patients.
Nobody died at the short-term. At the long-term period 7 patients (16.6%) passed away (all-cause mortality). Sudden cardiac death was observed in 2 cases. 1 patient died due to ischemic stroke. In 4 cases the reason of death was not established (unknown). Mean NYHA class at the follow-up was 1,9 (0.5). 9 patients (21.4%) suffered from residual LVOT obstruction. Just 1 patient underwent implantable cardioverter defibrillator insertion. 3/42 patients (7.1%) underwent the pacemaker insertion due to a complete heart blockage. 12-year survival were 78.9%. Multi-variant analysis identified age younger than 35 years before ASA (p=0.041, odds ratio 0.188, 95%CI: 0.034-1.038) and pacemaker implantation after ASA (p= 0.016, odds ratio 0.074, 95%CI: 0.006-0.968) as predictors for long-term death.
Long-term more than 10-years results of ASA look appropriate, and consistent with largest Euro-ASA registry. Unselected type of historical patient’s cohort might slightly decrease the effectiveness of such kind of therapy. Our data emphasize concern of ASA in patients younger 35 years.