Septal ethanol ablation for hypertrophic obstructive cardiomyopathy: early and intermediate results of a Canadian referral centre.
BACKGROUND
Septal ethanol ablation (SEA) is a relatively new interventional nonsurgical treatment for patients with hypertrophic obstructive cardiomyopathy (HOCM). This procedure involves targeted infarction of the basal interventricular septum to reduce left ventricular outflow tract (LVOT) obstruction.


OBJECTIVE
To describe the experience with this technique in a large tertiary care centre.


RESULTS
Since 1998, 40 HOCM patients with disabling symptoms refractory to medical treatment have undergone SEA. Procedural success was 88% (35 of 40 patients). The LVOT gradient decreased from 86+/-38 mmHg to 16+/-16 mmHg. There were two major complications: one patient died of respiratory failure at 30 days following SEA, and one patient developed a major coronary dissection during the procedure and required emergency myectomy and coronary bypass surgery. There were two late failures (6% of initially successful cases). In both patients, the LVOT gradient and symptoms reappeared some months after the procedure and further interventions were required. In the remaining patients, the gradient continued to decrease to one year; 86% were asymptomatic or have mild symptoms compared with 94% with severe symptoms before SEA. Septal thickness decreased from 20.8+/-2.9 mm to 13.2+/-3.3 mm (P<0.001) at the site of the targeted septal infarct.


CONCLUSIONS
SEA is a feasible option for suitable patients with HOCM.
Bhagwandeen
Rohan
R
Toronto General Hospital, Toronto, Canada.
Woo
Anna
A
Ross
John
J
Wigle
E Douglas
ED
Rakowski
Harry
H
Kwinter
Jennifer
J
Eriksson
Maria J
MJ
Schwartz
Leonard
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation; D015331:Cohort Studies; D003402:Creatine Kinase / Q000097:blood; D017147:Defibrillators, Implantable; D004452:Echocardiography; D004562:Electrocardiography; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000209:etiology / Q000628:therapy; D006329:Heart Conduction System / Q000473:pathology / Q000601:surgery; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012720:Severity of Illness Index; D012997:Solvents / Q000627:therapeutic use*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery
D012997:Solvents; D000431:Ethanol; D003402:Creatine Kinase