Abstract 4286: Predictors of Surgical-like Results With Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy
Background. Alcohol ablation has emerged as a therapy for patients with obstructive hypertrophic cardiomyopathy. However, questions remain about optimal selection criteria for the procedure.
Methods. We examined baseline and procedural variables of 163 patients (mean age, 63 yrs; 43% men) who underwent ablation at Mayo Clinic. Patients were contacted to determine vital status and symptoms. Successful outcome of ablation was defined as:
residual resting outflow tract gradient of ≤10 mmHg;
≥80% reduction in provocable gradient; and
survival at follow-up without class III/IV symptoms.
Results. Successful outcome occurred in 95 patients (59%). Variables that predicted procedural success included age, gradient, septal hypertrophy, and left anterior descending (LAD) diameter, which were the strongest co-variates. Using these variables in binary fashion, patients with ≥3 characteristics (age ≥65 yrs, gradient <100 mmHg, hypertrophy <18 mm, LAD diameter <4.0 mm) demonstrated superior 4-yr survival free of death and class III/IV symptoms (90.4%) in comparison to those with fewer characteristics (Figure⇓).
Conclusions. Using a rigid definition of success, ablation led to a favorable outcome in 59% of patients in this investigation. Superior outcomes are achieved in older patients, and those with lower gradients, smaller LAD diameter, and milder hypertrophy.