Safety and efficacy of alcohol septal ablation in patients with symptomatic concentric left ventricular hypertrophy and outflow tract obstruction.
BACKGROUND
Transcoronary septal ablation is efficacious for patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) and outflow-tract gradient (OTG). However, while patients with symptomatic concentric left ventricular hypertrophy (CLVH) may develop OTG, the safety and efficacy of septal ablation in these patients is unknown.


OBJECTIVE
To determine the potential safety and efficacy of transcoronary alcohol septal ablation in refractory, symptomatic patients with CLVH and significant OTG.


METHODS
We identified 9 patients (all female; age, 67.6 ± 8.7 years) with CLVH and OTG who underwent septal ablation on a compassionate basis and for symptomatic relief, with CLVH defined as left ventricular wall thickness > 15 mm in the absence of asymmetric septal hypertrophy. CLVH patients were compared with age-, sex- and OTGmatched HOCM patients (resting OTG, 56.7 ± 22.4 versus 58.3 ± 33.5 mmHg, respectively; p = 0.91).


RESULTS
In CLVH patients, mean resting OTG decreased to 22.8 ± 12.5 mmHg (p < 0.0005 versus baseline), which was comparable to the change in HOCM patients (p = 0.45 CLVH versus HOCM). Peak inducible OTG in CLVH patients also decreased following septal ablation (142.2 ± 36.3 to 36.1 ± 16.2 mmHg; p < 0.0001). Baseline left ventricular end-diastolic pressure (LVEDP) was similar between CLVH (17.7 ± 3.7 mmHg) versus HOCM (16.3 ± 4.0 mmHg; p = 0.50). Following ablation, LVEDP decreased by 3.4 ± 1.9 mmHg in CLVH (p < 0.001 versus baseline) and 3.0 ± 2.2 mmHg in HOCM patients (p = 0.67 CLVH versus HOCM). Complication rates were similar between groups. Baseline New York Heart Association class was 3.6 ± 0.5 for CLVH versus 3.3 ± 0.5 for HOCM (p = 0.51). Both groups experienced symptomatic improvement following ablation (p < 0.0005), and at long-term follow up (34.9 ± 23.9 months), these changes were similar and sustained.


CONCLUSIONS
Septal ablation holds promise for the management of symptomatic CLVH with OTG.
Cardiac Catheterization Laboratory, Cardiovascular Institute, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029, USA.
Jason C
JC
Kovacic
Deepak
D
Khanna
Dheeraj
D
Kaplish
Rucha
R
Karajgikar
Samin K
SK
Sharma
Annapoorna
A
Kini
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002312:Cardiomyopathy, Hypertrophic / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D015897:Comorbidity; D000431:Ethanol; D005260:Female; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*
D000431:Ethanol