Abstract 19664: Clinical Characteristics and Cardiac Magnetic Resonance for the Patients Received Repeating Alcohol Septal Ablation in Refractory Hypertrophic Obstructive Cardiomyopathy
Backgound: Alcohol septal ablation (ASA) is an alternative option to surgical myectomy, however, there are problems regarding the residual gradient and repeating septal reduction. Therefore, we investigated the patients’ characteristics needed repeating ASA with geometric analysis by cardiac magnetic resonance (CMR).
Method: We performed 174 ASA from 1998 to 2012, and there were 28 cases (Group R) needed repeating procedures because of recurrent drug-refractory symptoms due to intraventricular obstruction. We investigated the procedural details and the CMR findings to pursue the predictive factor of unsatisfied ASA result, in comparison with 36 patients (Group S) with successful procedures, in which the symptom improved to NYHA class I and there was no repeating ASA until 5 years from the first procedure.
Results: The time interval of both ASA procedures in group R was 584±496 days, and 16 patients (57%) received 2nd procedure within 1 years. In group R, the patients were younger (55±16 in group R and 65±13 years-old in group S, p=0.006), and similar to gender (Female 25 and 18), baseline pressure gradient (PG) (81±51 and 82±38 mmHg), ethanol dosage (2.2±1.0 and 2.2±0.9ml) than group S. Notably, the PG after ASA in group R was significantly higher (35±34 and 16±18mmHg, p=0.011), moreover the peak CPK was significantly lower (804±388 and 1206±533U/l, p=0.001). From CMR findings, the left ventricular mass, the left atrial diameter, the geometry of the left ventricle and late gadolinium enhancement were similar in both groups.
Conclusion: Younger patients, high PG after ASA and low peak CPK were likely to need repeating procedure. Therefore, sufficient ablation for culplit septal myocardium was desirable.
- © 2012 by American Heart Association, Inc.