Long-term follow-up after percutaneous septal ablation in hypertrophic obstructive cardiomyopathy.
OBJECTIVE
The aim of this study was to evaluate the longterm follow-up results of percutaneous transluminal septal myocardial ablation (PTSMA) in a large patient cohort.


BACKGROUND
PTSMA by alcohol injection into septal branches has shown good acute and short-term results in symptomatic patients with hypertrophic obstructive cardiomyopathy.


METHODS
A total of 100 consecutive symptomatic (NYHA class 2.8 +/- 0.6) patients underwent PTSMA. All patients had clinical and non-invasive follow-up at 3 months, 1 year, and annually up to 8 years.


RESULTS
One patient died at day 2 after intervention due to fulminant pulmonary embolism following deep venous thrombosis, and eight patients required a permanent DDD-pacemaker due to post-interventional complete heart block. Acute reduction of the left ventricular outflow tract gradient was achieved from 76 +/- 37 to 19 +/- 21 mmHg at rest, from 104 +/- 34 to 43 +/- 31 mmHg during Valsalva maneuver, and from 146 +/- 45 to 59 +/- 42 mmHg post extrasystole (p < 0.0001, each). During follow-up (mean follow-up time: 58 +/- 14 months), three additional patients died (sudden death at 48 months, non-cardiac death at 49 months and stroke-related death at 60 months after the index procedure). All living patients showed clinical improvement to NYHA-class 1.4 +/- 0.6 (after 3 months, n = 99), 1.5 +/- 0.6 (after 1 year, n = 99), and 1.6 +/- 0.7 at final follow-up (n = 96; p < 0.0001, each). Non-invasive follow-up studies documented ongoing outflow tract gradient reduction, decrease of septal and left ventricular posterior wall thickness, and improvement of exercise capacity.


CONCLUSIONS
PTSMA is an effective treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy. Follow-up showed ongoing hemodynamic and clinical improvement without increased mortality and morbidity.
Seggewiss
H
H
Medizinische Klinik 1, Leopoldina-Krankenhaus, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Germany. seggewiss.hubert@t-online.de
Rigopoulos
A
A
Welge
D
D
Ziemssen
P
P
Faber
L
L
D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D016009:Chi-Square Distribution; D003287:Contrast Media; D015150:Echocardiography, Doppler; D000431:Ethanol / Q000627:therapeutic use*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000187:drug effects; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides; D012997:Solvents / Q000627:therapeutic use*; D016019:Survival Analysis; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology
D003287:Contrast Media; D011134:Polysaccharides; D012997:Solvents; C059891:SHU 508; D000431:Ethanol