Abstract 3679: Short Term Outcome After Transluminal Alcohol Septal Ablation Using Systematic Echocardiographic Guidance
Introduction: Transluminal alcohol septal ablation (TASH) as emerged since 1995 as a good alternative to surgery in symptomatic hypertrophic obstructive cardiomyopathy (HOCM). Preliminary results have shown good acute and mid-tem results, but a relatively high rate of complete atrio-ventricular bloch (AVB) requiring permanent pace maker (PM) in up to 30% of cases. To optimize the strategy, increase the rate of success and decrease the risk of side effects, perprocedural echo-guidance as been proposed.
Objective and methods: To assess in a prospective registry the in-hospital outcome of Echo-guided TASH in patients with symptomatic HOCM.
Results: Between November 1999 and February 2006, 91 patients were enrolled consecutively (96 TASH procedures). No patients were excluded due to septal access difficulties. Patients were 55.7±17.2 years old, 57% male, NYHA class II in 24% of cases, III in 58% and IV in 18%, 28.6% were already treated with a PM and 1.2% had a intra cardiac defibrillator. The septal thickness pre-procedure was 24±8 mm and basal intraventricular gradient 88±41 mmHg. After injection of 1.9±0.6 ml of ethanol under echo-guidance in 1.3±0.2 septal branches, the procedure was successfull (decrease of intraventricular gradient > 50%) in 97.% of cases. Except conduction disturbance, no complications were observed during the procedure. Heart block requiring temporary PM was observed in 16.7% of cases and these patients had a definitive PM in 9.5%. The maximal CPK elevation after the procedure was 1146±412 IU. Hospital stay in the intensive care unit was 5.2±1.9 days and total hospital stay 7.1±2.2 days. In-hospital death occurred in 2 cases (2.4%) at day 2 and day 3 while the patient was still in the intensive care unit.
Conclusion: TASH using systematicaly echocardiographic guidance is associated with a high rate of success and a low rate of irreversible atrio-ventricular block requiring permanent pace-maker.