Abstract 3598: Percutaneous Transluminal Septal Coil Embolization for Hypertrophic Obstructive Cardiomyopathy
Background: Alcohol septal ablation (ASA) is an effective treatment of severely symptomatic patients with hypertrophic obstructive cardiomyopathy. However, ASA frequently induces complete heart block requiring permanent pacing. The goal of this study was to evaluate the feasibility and the efficiency of non surgical septal reduction by coil septal embolisation.
Methods and Results: Twenty patients (11 males, 54 ± 15 years old) presented with septal myocardial hypertrophy (≥ 17 mm), drug refractory symptoms despite optimal medical therapy, and resting or stress-induced left ventricular outflow tract (LVOT) gradient of at least 50 mmHg on continuous wave Doppler echocardiography were included in the study. The area at risk per perforator septal branch was analysed by contrast echocardiography. 3.6 ± 1.9 coils per patients were needed to occlude septal perforator branches. We did neither detect severe ventricular arrhythmia nor permanent atrioventricular blockage following the procedure. Two patients presented permanent bundle branch block. Cardiac MRI was performed at baseline 5 days after the procedure and showed a transmural perfusion defect in the proximal septal region only in 4 patients. Delayed contrast-enhanced images showed in all patients extension of patchy areas of hyperenhanced myocardial in the interventricular septum. No reflow was absent in all patients. At six month follow-up, NYHA functional class was improved (2.8 ± 0.5 to 1.4 ±0.5, p=0.0001), and peak oxygen consumption significantly increased as compared to baseline (14.8 ±4.5 vs 18.3 ±4.6 ml/kg/min, p=0.001). Echocardiographic examination showed a significant reduction of the end-diastolic interventricular septal thickness (21 ± 3 vs 18 ±4 mm, p=0.00001). Furthermore, LVOTG significantly decreased from (80 ±25 vs 39 ± 28 mm Hg, p=0.001).
Conclusions: Coil septal ablation appears as a successful strategy in patients with severe hypertrophic obstructive cardiomyopathy without complete heart block. Further studies are warranted to compare coil and alcohol septal ablation.