This Article Free upon publication Full Text Full Text (PDF) CME: Take the course for this article: Circulation: July 8, 2008, Volume 118, Number 2 All Versions of this Article: 118/2/131    most recent CIRCULATIONAHA.107.738740v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Sorajja, P. Articles by Holmes, D. R. PubMed PubMed Citation Articles by Sorajja, P. Articles by Holmes, D. R., Jr Related Collections Myocardial cardiomyopathy disease Related Article

(Circulation. 2008;118:131-139.)
© 2008 American Heart Association, Inc.

Heart Failure

Outcome of Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy

Paul Sorajja, MD; Uma Valeti, MD; Rick A. Nishimura, MD; Steve R. Ommen, MD; Charanjit S. Rihal, MD; Bernard J. Gersh, MB, ChB, DPhil; David O. Hodge, MS; Hartzell V. Schaff, MD; David R. Holmes, Jr, MD

From the Division of Cardiovascular Diseases and Internal Medicine (P.S., U.V., R.A.N., S.R.O., C.S.R., B.J.G., D.R.H.), Department of Biostatistics (D.O.H.), and Department of Cardiovascular Surgery (H.V.S.), Mayo Clinic College of Medicine, Rochester, Minn.

Correspondence to Paul Sorajja, MD, 200 1st St SW, Rochester, MN 55905. E-mail paul.sorajja{at}mayo.edu

Received July 4, 2007; accepted May 2, 2008.

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<0.0001). Four-year survival free of all mortality was 88.0% (95% confidence interval, 79.4 to 97.5%), which was similar to that of the age- and gender-matched patients who had undergone myectomy (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.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2008 118: 105-106. [Full Text]