Abstract 14784: Long-Term Follow-up After Myocardial Contrast Echocardiography-Guided Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy
Aim: Report the immediate and long-term results of alcohol septal ablation (ASA) guided by myocardial contrast echocardiography (MCE) for treatment of symptomatic hypertrophic obstructive cardiomyopathy from a high-volume centre.
Methods and results: From 2000 to 2011, 161 patients (88 males) underwent ASA. Mean age was 56.4±15.9 years (range 8-87). Medical treatment included beta-blockers (75%), calcium-channel antagonists (49%) and disopyramide (2%). 22% had prior pacemaker (PM) implantation, 3% prior implantable cardioverter-defibrillator (ICD) and 4% prior cardiac surgery. At baseline, mean New York Heart Association (NYHA) functional class was 2.8±0.6. Mean left ventricular outflow tract (LVOT) peak gradient and septal thickness were 92±45mmHg and 23.0±3.8 mm, respectively. During ASA, 2.0±0.8ml of absolute alcohol was injected in 1.2±0.4 septal perforators. Final procedural LVOT peak gradient was 20±22mmHg. Procedural success (immediate LVOT peak gradient reduction >50%) was achieved in 94%. Complications included coronary dissection requiring stent implantation (1 procedure). There were 2 in-hospital deaths (1 refractory ventricular arrhythmia, 1 complete atrioventricular block). In-hospital permanent PM implantation was required following 8.7% of procedures. One patient required an ICD for non-sustained ventricular tachycardia. Mean peak CK was 932±491 IU/L. At a mean follow-up of 2.3±1.8 years after the procedure (range 0-8.4), there were 7 additional deaths (overall annual mortality of 2%). Repeat ASA was required in 12 patients (7%) and a new ICD was needed in 1 patient (5%). Mean NYHA class was improved to 1.2±0.5.
Conclusion: MCE-guided ASA is associated with a high rate of immediate success and a low rate of procedural complications. In addition, long-term follow-up shows sustained clinical benefit with a low rate of adverse events (annual mortality lower than the expected rate of 3-4% in this high-risk population).
- © 2011 by American Heart Association, Inc.