title: Updated meta-analysis of septal alcohol ablation versus myectomy for hypertrophic cardiomyopathy.
abstract: OBJECTIVE
  The purpose of this study was to perform a systematic review and meta-analysis of comparative studies to compare outcomes of septal ablation (SA) with septal myectomy (SM) for treatment of hypertrophic obstructive cardiomyopathy (HOCM).
  
  
  BACKGROUND
  SM is considered the gold standard for treatment of HOCM. However, SA has emerged as an attractive therapeutic alternative.
  
  
  METHODS
  A Medline search using standard terms was conducted to determine eligible studies. Due to a lack of randomized control trials, we included observational studies for review.
  
  
  RESULTS
  Twelve studies were found eligible for review. No significant differences between short-term (risk difference [RD]: 0.01; 95% confidence interval [CI]: -0.01 to 0.03) and long-term mortality (RD: 0.02; 95% CI: -0.05 to 0.09) were found between the SA and SM groups. In addition, no significant differences could be found in terms of post-intervention functional status as well as improvement in New York Heart Association functional class, ventricular arrhythmia occurrence, re-interventions performed, and post-procedure mitral regurgitation. However, SA was found to increase the risk of right bundle branch block (RBBB) (pooled odds ratio [OR]: 56.3; 95% CI: 11.6 to 273.9) along with need for permanent pacemaker implantation post-procedure (pooled OR: 2.6; 95% CI: 1.7 to 3.9). Although the efficacy of both SA and SM in left ventricular outflow tract gradient (LVOTG) reduction seems comparable, there is a small yet significantly higher residual LVOTG amongst the SA group patients as compared with the SM group patients.
  
  
  CONCLUSIONS
  SA does seem to show promise in treatment of HOCM owing to similar mortality rates as well as functional status compared with SM; however, the caveat is increased conduction abnormalities and a higher post-intervention LVOTG. The choice of treatment strategy should be made after a thorough discussion of the procedures with the individual patient.
authors.affiliation: Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Shikhar
authors.initials: S
authors.lastname: Agarwal
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.forename: Milind Y
authors.initials: MY
authors.lastname: Desai
authors.forename: Nicholas
authors.initials: N
authors.lastname: Smedira
authors.forename: Harry M
authors.initials: HM
authors.lastname: Lever
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D002312:Cardiomyopathy, Hypertrophic / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D008297:Male; D016896:Treatment Outcome
chemical_list: D000431:Ethanol