title: Alcohol septal ablation for the treatment of hypertrophic obstructive cardiomyopathy. A multicenter North American registry.
abstract: OBJECTIVE
  The purpose of the study is to identify the predictors of clinical outcome (mortality and survival without repeat septal reduction procedures) of alcohol septal ablation for the treatment of patients with hypertrophic obstructive cardiomyopathy.
  
  
  BACKGROUND
  Alcohol septal ablation is used for treatment of medically refractory hypertrophic obstructive cardiomyopathy patients with severe outflow tract obstruction. The existing literature is limited to single-center results, and predictors of clinical outcome after ablation have not been determined. Registry results can add important data.
  
  
  METHODS
  Hypertrophic obstructive cardiomyopathy patients (N = 874) who underwent alcohol septal ablation were enrolled. The majority (64%) had severe obstruction at rest, and the remaining had provocable obstruction. Before ablation, patients had severe dyspnea (New York Heart Association [NYHA] functional class III or IV: 78%) and/or severe angina (Canadian Cardiovascular Society angina class III or IV: 43%).
  
  
  RESULTS
  Significant improvement (p < 0.01) occurred after ablation (~5% in NYHA functional classes III and IV, and 8 patients in Canadian Cardiovascular Society angina class III). There were 81 deaths, and survival estimates at 1, 5, and 9 years were 97%, 86%, and 74%, respectively. Left anterior descending artery dissections occurred in 8 patients and arrhythmias in 133 patients. A lower ejection fraction at baseline, a smaller number of septal arteries injected with ethanol, a larger number of ablation procedures per patient, a higher septal thickness post-ablation, and the use beta-blockers post-ablation predicted mortality.
  
  
  CONCLUSIONS
  Variables that predict mortality after ablation, include baseline ejection fraction and NYHA functional class, the number of septal arteries injected with ethanol, post-ablation septal thickness, beta-blocker use, and the number of ablation procedures.
authors.affiliation: Methodist DeBakey Heart and Vascular Center, 6550 Fannin, Houston, TX 77030 USA. snagueh@tmhs.org
authors.forename: Sherif F
authors.initials: SF
authors.lastname: Nagueh
authors.forename: Bertron M
authors.initials: BM
authors.lastname: Groves
authors.forename: Leonard
authors.initials: L
authors.lastname: Schwartz
authors.forename: Karen M
authors.initials: KM
authors.lastname: Smith
authors.forename: Andrew
authors.initials: A
authors.lastname: Wang
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bach
authors.forename: Christopher
authors.initials: C
authors.lastname: Nielsen
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Leya
authors.forename: John M
authors.initials: JM
authors.lastname: Buergler
authors.forename: Steven K
authors.initials: SK
authors.lastname: Rowe
authors.forename: Anna
authors.initials: A
authors.lastname: Woo
authors.forename: Yolanda Munoz
authors.initials: YM
authors.lastname: Maldonado
authors.forename: William H
authors.initials: WH
authors.lastname: Spencer
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000789:Angina, Unstable / Q000628:therapy; D002312:Cardiomyopathy, Hypertrophic / Q000401:mortality / Q000628:therapy*; D017023:Coronary Angiography; D004417:Dyspnea / Q000628:therapy; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America; D012042:Registries; D013318:Stroke Volume; D018084:Ultrasonography, Interventional; D014694:Ventricular Outflow Obstruction / Q000401:mortality / Q000628:therapy*
chemical_list: D000319:Adrenergic beta-Antagonists; D000431:Ethanol