Clinical and Functional Outcome of Percutaneous Alcohol Septal Ablation in Obstructive Hypertrophic Cardiomyopathy

Gustavo O. Pedernera, Gustavo Avegliano, Gerardo Nau, Juan M. Vrancic, Mirta Díez, Alfonsina Candiello, Diego Conde, Paola Kushnir, Fernando A. Cura

Abstract


Background: Percutaneous septal ablation is a therapeutic option for patients with obstructive hypertrophic cardiomyopathyrefractory to optimal medical therapy. However, results of initial persistence and long-term safety are still controversial.Objectives: The aim of this study was to report percutaneous alcohol septal ablation technique, clinical and functional outcome,cardiovascular events and its impact on long-term follow-up.Methods: A total of 23 patients were included in the study. Functional class (FC), left ventricular outflow tract gradient beforeand after the procedure and long-term cardiovascular events were evaluated.Results: Median follow-up was 52 months (IR 33-72). All patients were in FC III or IV prior to the procedure, under maximumtolerated medical therapy. The procedure was successful in 91% of cases, with 85% of patients currently in FC I and 15% inFC II. Baseline left ventricular outflow tract gradient decreased from 75 mmHg (95% CI 51-89) to 25 mmHg (95% CI 10-37)(p<0.003) and with Valsalva maneuver from 118 mmHg (95% CI 88-152) to 38 mmHg (IC 95% 16-69) (p<0.0002), persistingin the long-term follow-up. During hospitalization, two patients presented with complete atrioventricular block requiringpermanent pacemaker implantation. No cardiovascular deaths occurred during follow up.Conclusions: Alcohol septal ablation is a promising option for the treatment of a selected population with hypertrophicobstructive cardiomyopathy, generating sustained clinical and functional improvement with low incidence of events in thelong-term follow up.

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar