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Original research article
Alcohol septal ablation in patients with severe septal hypertrophy
  1. Josef Veselka1,
  2. Morten Jensen2,
  3. Max Liebregts3,
  4. Robert M Cooper4,
  5. Jaroslav Januska5,
  6. Maksim Kashtanov6,7,
  7. Maciej Dabrowski8,
  8. Peter Riis Hansen9,
  9. Hubert Seggewiss10,11,
  10. Eva Hansvenclova1,
  11. Henning Bundgaard2,
  12. Jurrien ten Berg3,
  13. Rodney Hilton Stables4,
  14. Lothar Faber11
  1. 1Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
  2. 2Unit for Inherited Cardiac Diseases, Department of Cardiology, Copenhagen University Hospitalet Rigshospitalet, Copenhagen, Denmark
  3. 3Department of Cardiology, St. Antonius Hospitalen Nieuwegein, Nieuwegein, The Netherlands
  4. 4Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK
  5. 5Cardiocentre Podlesi, Trinec, Czech Republic
  6. 6Ural Federal University, Sverdlovsk, Russian Federation
  7. 7Yekaterinburg Regional Hospital No.1, Yekaterinburg, Russian Federation
  8. 8Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
  9. 9Department of Cardiology, Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark
  10. 10Department of Internal Medicine, Juliusspital Wuerzburg, Wuerzburg, Germany
  11. 11Clinic for General and Interventional Cardiology, Heart and Diabetes Centre NRW Ruhr-University Bochum, Bad Oeynhausen, Germany
  1. Correspondence to Dr Josef Veselka, Dpt. of Cardiology, University Hospital Motol, Prague 15000, Czech Republic; veselka.josef{at}seznam.cz

Abstract

Objective The current guidelines suggest alcohol septal ablation (ASA) is less effective in hypertrophic obstructive cardiomyopathy (HOCM) patients with severe left ventricular hypertrophy, despite acknowledging that systematic data are lacking. Therefore, we analysed patients in the Euro-ASA registry to test this statement.

Methods We compared the short-term and long-term outcomes of patients with basal interventricular septum (IVS) thickness <30 mm Hg to those with ≥30 mm Hg treated using ASA in nine European centres.

Results A total of 1519 patients (57±14 years, 49% women) with symptomatic HOCM were treated, including 67 (4.4%) patients with IVS thickness ≥30 mm. The occurrence of short-term major adverse events were similar in both groups. The mean follow-up was 5.4±4.3 years and 5.1±4.1 years, and the all-cause mortality rate was 2.57 and 2.94 deaths per 100 person-years of follow-up in the IVS <30 mm group and the IVS ≥30 mm group (p=0.047), respectively. There were no differences in dyspnoea (New York Heart Association class III/IV 12% vs 16%), residual left ventricular outflow tract gradient (16±20 vs 16±16 mm Hg) and repeated septal reduction procedures (12% vs 18%) in the IVS <30 mm group and IVS ≥30 mm group, respectively (p=NS for all).

Conclusions The short-term results and the long-term relief of dyspnoea, residual left ventricular outflow obstruction and occurrence of repeated septal reduction procedures in patients with basal IVS ≥30 mm is similar to those with IVS <30mm. However, long-term all-cause and cardiac mortality rates are worse in the ≥30 mm group.

  • hypertrophic cardiomyopathy
  • alcohol septal ablation
  • prognosis
  • survival
  • outflow gradient
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Footnotes

  • Contributors JV drafted the MS, performed statistical analysis, conceived and designed the research and acquired the data; MKJ, ML, RC, JJ, MK, MD, PRH, HS, EH, HB, JB RHS, LF collected data and made criticalrevision of the MS.

  • 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 consent for publication Not required.

  • Ethics approval Multicentre Ethical Committee Motol, Prague, approved the protocol.

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

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

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