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. 2006 Dec 5;28(3):124–130. doi: 10.1002/clc.4960280305

A prospective follow‐up of alcohol septal ablation for symptomatic hypertrophic obstructive cardiomyopathy—The baylor experience (1996–2002)

Valerian L Fernandes 1, Sherif F Nagueh 2, Jennifer Franklin 2, Wei Wang 1, Robert Roberts 2, William H Spencer III 1,2,✉
PMCID: PMC6654248  PMID: 15813618

Abstract

Background: There is a paucity of data on the long‐term outcome of alcohol septal ablation (ASA) for symptomatic hypertrophic obstructive cardiomyopathy (HOCM).

Hypothesis: The study was undertaken to evaluate the longer‐term outcome of ASA therapy for symptomatic HOCM.

Methods: In all, 137 patients were enrolled consecutively (1996–1999) and 130 (95%) (74 men, 56 women, aged 51 ± 17 years) underwent ASA and had serial prospective follow‐up for up to 5 years (mean follow‐up 3.6 ± 1.4 years). Evaluation included angina (Canadian Cardiovascular Society [CCS] score), dyspnea (New York Heart Association [NYHA] class), duration of exercise on treadmill, and echocardiographic indices.

Results: Ethanol (3.5 ± 1.5 cc), injected into 1.5 ± 0.6 arteries, induced a mean peak plasma creatine kinase (CK) of 1676 ± 944 units. Complications of procedures included death 1.5% (2/130), heart block requiring permanent pacemaker 13% (17/130), and coronary dissection 4.4% (6/130). Baseline versus last follow‐up visit: NYHA class decreased from 3.0 ± 0.4 to 1.2 ± 0.6 (p < 0.01); CCS angina score from 2.0 ± 0.8 to 0.08 ± 0.4 (p < 0.01); and duration of exercise increased from 322 ± 207 to 443 ± 200s (p < 0.01). Resting left ventricular outflow tract gradient at baseline versus last follow‐up visit showed a decrease from 74 ± 30 to 4 ± 13 (p < 0.01), and the dobutamine‐provoked gradient of 88 ± 29 decreased to 21 ± 21 (p < 0.01) mmHg. All‐cause mortality over the duration of follow‐up was 7.7% (10) giving an annual rate of 2.1%, and cardiac mortality was 2.3% (3) reflecting an annual rate of 0.6%.

Conclusions: Alcohol septal ablation decreased symptoms and improved exercise performance, indicating that it is an effective procedure for symptomatic HOCM.

Keywords: hypertrophic, cardiomyopathy, alcohol, septal, ablation, myectomy, gradient

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