Long-term survival after alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a comparison with general population.
OBJECTIVE
We decided to determine the long-term survival of patients after alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) and compare this with the general population.


RESULTS
A total of 178 highly symptomatic, consecutive patients (58 ± 12 years, 53% women) were treated by ASA between April 1998 and April 2013 and followed-up for 4.8 years (IQR 2.1-7.5). At baseline, 155 patients (87%) suffered from dyspnoea ≥3 class of NYHA; at the most recent examination, 87 patients (49%) and 23 patients (13%) reported dyspnoea of NYHA class 1 and ≥3, respectively. The left ventricular outflow gradient was significantly reduced (68 ± 42 vs. 20 ± 25 mmHg; P < 0.01). A total of 19 deaths (11%) occurred during 925 patient-years, which means an overall mortality rate of 2.1% per year. Survival free of all-cause mortality at 1, 5, and 10 years was 97% (95% CI, 93-99%), 92% (95% CI, 87-96%), and 82% (95% CI, 70-90%), respectively. This observed mortality was comparable to the expected survival for age- and sex-comparable general population (P = 0.34). According to multivariate analysis, the only independent predictor of all-cause mortality was age at ASA (hazard ratio 1.09, 95% CI 1.04-1.14; P < 0.01).


CONCLUSIONS
This study suggests that in patients with HOCM and important symptoms who underwent ASA, long-term survival after the procedure did not differ significantly from that of the general population.
Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic veselka.josef@seznam.cz.
Josef
J
Veselka
1st Department of Internal Medicine/Cardioangiology, International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic.
Jan
J
Krejčí
Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic.
Pavol
P
Tomašov
Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic.
David
D
Zemánek
D055011:Ablation Techniques / Q000379:methods* / Q000401:mortality; D002312:Cardiomyopathy, Hypertrophic / Q000401:mortality / Q000601:surgery*; D017147:Defibrillators, Implantable; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006346:Heart Septum; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012997:Solvents / Q000627:therapeutic use*; D016019:Survival Analysis; D016896:Treatment Outcome
D012997:Solvents; D000431:Ethanol
Alcohol septal ablation; Hypertrophic cardiomyopathy; Prognosis