title: Alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy: low incidence of sudden cardiac death and reduced risk profile.
abstract: BACKGROUND
  The infarction induced by alcohol septal ablation (ASA) may predispose to arrhythmia and sudden cardiac death (SCD).
  
  
  OBJECTIVE
  To assess survival, incidence of SCD after ASA and effects of ASA on the traditional risk factors (RFs) for SCD.
  
  
  METHODS
  An observational cohort-study (follow-up 8.4±4 years).
  
  
  METHODS
  A dual-centre cohort.
  
  
  METHODS
  470 consecutive patients (age 56±14 years) with obstructive hypertrophic cardiomyopathy (HCM) (1996-2010).
  
  
  METHODS
  Clinically applied echo-contrast-guided ASA treatments.
  
  
  METHODS
  All-cause mortality, SCD and RFs for SCD before and after ASA.
  
  
  RESULTS
  The 10-year survival was 88% (annual all-cause death rate 1.2%) after ASA compared with 84% (p=0.06) in a matched background population. The 10-year survival free of SCD was 95% (annual SCD rate 0.5%). ASA reduced the prevalence of abnormal blood pressure response (from 23% to 9%, p<0.001), syncope (26% to 2%, p<0.001), non-sustained ventricular tachycardia (NSVT) (23% to 17%, p<0.05) and maximal wall thickness ≥30 mm (7% to 2%, p<0.001). There was a family history of SCD in 19% of the patients. The proportion of patients at high risk-that is, two or more RFs (n=89), was reduced from 25% to 8% (p<0.001). A RF score ≥2 before ASA was not associated with SCD (n=361, p=0.31).
  
  
  CONCLUSIONS
  Survival in ASA-treated patients was similar to that in the background population. The number of RFs, including the prevalence of NSVT, was markedly reduced by ASA and the incidence of SCD was correspondingly low. Thus, clinically applied ASA was safe.
authors: Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark. mortenjensen@dadlnet.dk
authors: Morten K
authors: MK
authors: Jensen
authors: Christian
authors: C
authors: Prinz
authors: Dieter
authors: D
authors: Horstkotte
authors: Frank
authors: F
authors: van Buuren
authors: Thomas
authors: T
authors: Bitter
authors: Lothar
authors: L
authors: Faber
authors: Henning
authors: H
authors: Bundgaard
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology; D003718:Denmark / Q000453:epidemiology; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012997:Solvents / Q000627:therapeutic use; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D012997:Solvents; D000431:Ethanol