Outcome of Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy
| Autor: | Charanjit S. Rihal, Hartzell V. Schaff, David R. Holmes, Paul Sorajja, Steve R. Ommen, Uma S. Valeti, Bernard J. Gersh, Rick A. Nishimura, David O. Hodge |
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| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty Alcohol septal ablation Heart disease Cardiomyopathy Septal Ablation Physiology (medical) Internal medicine Heart Septum Humans Medicine Aged business.industry Age Factors Hypertrophic cardiomyopathy Arrhythmias Cardiac Cardiomyopathy Hypertrophic Middle Aged medicine.disease Survival Analysis Septal myectomy Heart septum Surgery Treatment Outcome Alcohols Catheter Ablation Cardiology Female Tamponade Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circulation. 118:131-139 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/circulationaha.107.738740 |
| Popis: | Background— The clinical efficacy of alcohol septal ablation for drug-refractory hypertrophic cardiomyopathy remains unclear. This study examines the outcome of alcohol septal ablation performed at a tertiary hypertrophic cardiomyopathy referral center. Methods and Results— Among 601 patients with severely symptomatic obstructive hypertrophic cardiomyopathy referred for alcohol septal ablation or myectomy from 1998 to 2006, 138 patients (median age, 64 years; 39% men) chose to undergo ablation. Procedural complications included death in 1.4%, sustained ventricular arrhythmias in 3%, tamponade in 3%, and pacemaker implantation in 20%. This rate was higher than a combined complication rate of 5% in age- and gender-matched patients who had undergone septal myectomy at Mayo Clinic ( P P =0.18). Six patients had documented ventricular arrhythmias after ablation, 4 of whom had successful intervention. Four-year survival free of death and severe New York Heart Association class III/IV symptoms after septal ablation was 76.4%, and 71 patients (51%) became asymptomatic. Myectomy patients ≤65 years of age had significantly better survival free of death and severe symptoms ( P =0.01). Conclusions— Alcohol septal ablation is an efficacious procedure if performed in an experienced institution and may resolve symptoms in a subset of patients with obstructive hypertrophic cardiomyopathy. However, the procedural complication rate exceeds that of myectomy. Patients ≤65 years of age have better symptom resolution with myectomy. No impairment in short-term survival was noted in this nonrandomized study, but the long-term outcome remains unknown. |
| Databáze: | OpenAIRE |
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