title: Alcohol septal ablation for obstructive hypertrophic cardiomyopathy: outcomes in young, middle-aged, and elderly patients.
abstract: OBJECTIVE
  We compared the efficacy and safety of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) in young, middle-aged, and elderly patients.
  
  
  BACKGROUND
  Intersociety guidelines suggest based on limited evidence that young patients with medically refractory symptoms of obstructive HCM should undergo surgical myectomy while elderly patients may be more appropriate for ASA.
  
  
  METHODS
  Data for 360 patients undergoing 389 ASAs were prospectively collected and retrospectively analyzed according to age.
  
  
  RESULTS
  Young (<45 years), middle-aged (45-64 years), and elderly (≥65 years) patients comprised 28, 40, and 32% of the study population, respectively. Young patients had thicker left ventricular septal walls at baseline, and elderly patients had more comorbidity and dyspnea. Resting, mean left ventricular outflow tract gradients (LVOTGs) were similar across the age groups at baseline (62, 66, and 68 mm Hg, respectively; P = NS for all comparisons). LVOTGs and dyspnea were significantly and similarly improved in all age groups immediately after ASA and through 12 months of follow-up (P < 0.001 for before and after comparisons; P = NS for intergroup comparisons). Complication rates were similar for young and middle-aged patients but higher for elderly patients (9.1 and 6.3% vs. 20.8%, respectively; P ≤ 0.016 for elderly vs. others). Mortality rates for young and middle-aged patients were lower than for elderly patients, but the differences were not statistically significant.
  
  
  CONCLUSIONS
  Patients undergoing ASA had significant and similar improvements in LVOTGs and symptoms regardless of age. Procedural complications were increased in elderly patients, who had numerically but not statistically significantly higher mortality rates.
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Leonardi
authors.forename: Jacob C
authors.initials: JC
authors.lastname: Townsend
authors.forename: Chetan A
authors.initials: CA
authors.lastname: Patel
authors.forename: Bethany J
authors.initials: BJ
authors.lastname: Wolf
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Todoran
authors.forename: Eric R
authors.initials: ER
authors.lastname: Powers
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Steinberg
authors.forename: Valerian L
authors.initials: VL
authors.lastname: Fernandes
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Nielsen
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000401:mortality; D000328:Adult; D000367:Age Factors; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015897:Comorbidity; D000431:Ethanol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000431:Ethanol