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Heart failure and cardiomyopathies
Original research
Alcohol septal ablation in patients aged 75 years or older with hypertrophic obstructive cardiomyopathy
  1. Dennis Lawin,
  2. Christoph Stellbrink,
  3. Ekaterina Stellbrink,
  4. Benjamin Buck,
  5. Madan Raj Poudel,
  6. Andi Tego,
  7. Kristin Marx,
  8. Thorsten Lawrenz
  1. Department of Cardiology and Intensive Care Medicine, University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Bielefeld, Germany
  1. Correspondence to Dr Dennis Lawin, Department of Cardiology and Intensive Care Medicine, University Hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Bielefeld, Germany; dennis.lawin{at}klinikumbielefeld.de

Abstract

Objective Outcome data for patients ≥75 years with hypertrophic obstructive cardiomyopathy (HOCM) undergoing alcohol septal ablation (ASA) are lacking. Therefore, a retrospective single-centre analysis was conducted.

Methods The data of all consecutive ASAs, that were performed at our institution between 1 September 1997 and 31 July 2021 in patients with HOCM with left ventricular outflow tract gradients (LVOTG) ≥50 mm Hg, were collected from patient reports. ASA was performed per institutional standards with 95% ethanol infused into a feasible septal branch. Differences regarding echocardiographic, procedural and clinical parameters at baseline and after 6 months between patients ≥75 years and <75 years were assessed.

Results We found 208 ASAs in patients ≥75 years (85.1% female; age 78.0 years (IQR 76.0–80.0)) and 1430 ASAs in patients <75 years (42.0% female; age 56.0 years (IQR 46.0–65.0)). Patients ≥75 years had lower distances in 6 min walk test (baseline: 317.0 m (IQR 242.0–389.0) vs 438.0 m (IQR 353.3–504.0); p<0.0001). Exercise-induced LVOTG calculated at follow-up was lower in patients ≥75 years (29.5 mm Hg (IQR 18.0–54.0) vs 39.5 mm Hg (IQR 23.0–73.8); p=0.0007). There were more high-degree AV blocks after ASA in patients ≥75 years (25.5% vs 13.6%; p<0.0001). The in-hospital mortality did not differ between the groups (age ≥75 years: 1.0%; age <75 years: 0.6%; p=0.6580).

Conclusion ASA had similar efficacy and intrahospital mortality in patients ≥75 years compared with younger patients. Higher rates of AV block with need for permanent pacemaker implantation were observed in patients ≥75 years of age.

  • cardiomyopathy, hypertrophic

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/heartjnl-2023-322659

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Twitter @DennisLawin

    • Contributors DL mainly performed the analysis, wrote the manuscript and, as the guarantor, he is responsible for the overall content. All coauthors contributed to the collection of data and analysis. The study was initiated and supervised by TL, who approved the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.