Abstract 14821: Long-Term Follow-up After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy in Young Adults
Aim: To assess the long-term safety and efficacy of alcohol septal ablation (ASA) in young adults.
Methods: Data of 163 consecutive patients who underwent ASA at our institution from 2000 to 2010 were reviewed. Clinical follow-up was obtained at a mean of 3 years after ASA in patients aged between 18 and 40 years at the time of the procedure.
Results: During the study period, 21 patients (15 males) aged between 18 and 40 years old (mean age 33.1±5.6, range 18-39 years) underwent ASA. Among them, 76% were treated with beta-blockers, 33% calcium-channel antagonists and 5% disopyramide. There were 6 patients (29%) with prior pacemaker, 1 patient (5%) with history of sudden death and prior implantable cardioverter-defibrillator (ICD) and 1 patient (5%) with prior myectomy. At baseline, mean New York Heart Association (NYHA) functional class was 2.4±0.5. Mean left ventricular outflow tract (LVOT) peak gradient and septal thickness were 89±37mmHg and 24.9±5.1 mm, respectively. All procedures were performed with myocardial contrast echocardiography guidance. During ASA, 2.2±0.7ml of absolute alcohol was injected in 1.4±0.5 septal perforators. Final procedural LVOT peak gradient was 20±16mmHg. Procedural success (defined as immediate LVOT peak gradient reduction >50%) was achieved in 20 patients (95%). There were no major complications. One patient (5%) required a temporary pacemaker for second-degree atrioventricular block. Mean peak CK was 934±468 IU/L. At a mean follow-up of 3.0±2.0 years after the procedure (range 0.3-8.4), repeat ASA was performed in two patients (10%) and a new ICD was needed in 1 patient (5%), while there were no fatalities reported. Mean NYHA class was improved to 1.6±0.7.
Conclusion: ASA in young patients appears to be safe and effective. Immediate success is achieved in a large majority of patients and procedural complication rates are low. In addition, 3-year follow-up shows sustained clinical benefit with a low rate of adverse events.
- © 2011 by American Heart Association, Inc.