title: Alcohol septal ablation for hypertrophic obstructive cardiomyopathy - 8 years follow up.
abstract: BACKGROUND
  Alcohol septal ablation is emerging as an alternative to surgical myectomy in the management of symptomatic cases of Hypertrophic obstructive cardiomyopathy (HOCM). This involves injection of absolute alcohol into 1st septal perforator thereby producing myocardial necrosis with resultant septal remodelling within 3-6 months. This results in reduction of septal thickness and LV outflow gradients with improvement in symptoms.
  
  
  METHODS
  Fifty three patients had undergone alcohol septal ablation, there were 2 early and 2 late deaths and 4 patients lost to follow up. Forty-five (85%) of them were followed up to a mean period of 96 ± 9.2 months. Clinical, ECG, and Echocardiographic parameters were evaluated during follow up.
  
  
  RESULTS
  Only 4 out of 51 patients remained in NYHA class III or IV at the end of 6 months. Significant reduction of LV outflow gradients (79 ± 35 to 34 ± 23 mmHg) and septal thickness (23 ± 4.7 mm to 19 ± 3 mm) were observed during 6 months follow up. Beyond 6 months there was no further decrease in either septal thickness or LVOT gradients noted. Ten percent of patients needed pacemaker implantation. There was 92% survival at the end of 8 years.
  
  
  CONCLUSIONS
  Alcohol septal ablation is a safe and effective nonsurgical procedure for the treatment of HOCM. By minimizing the amount of alcohol to ≤ 2 ml, one can reduce complications and mortality. The long-term survival is gratifying.
authors.affiliation: Sr. Interventional Cardiologist & Director, Dept of Cardiology, Apollo Hospitals, Chennai 600006, India. Electronic address: drismurthy@gmail.com.
authors.forename: I
authors.initials: I
authors.lastname: Sathyamurthy
authors.affiliation: Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India.
authors.forename: Rajeshwari
authors.initials: R
authors.lastname: Nayak
authors.affiliation: Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India.
authors.forename: Abraham
authors.initials: A
authors.lastname: Oomman
authors.affiliation: Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India.
authors.forename: K
authors.initials: K
authors.lastname: Subramanyan
authors.affiliation: Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India.
authors.forename: Mathew Samuel
authors.initials: MS
authors.lastname: Kalarical
authors.affiliation: Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India.
authors.forename: Robert
authors.initials: R
authors.lastname: Mao
authors.affiliation: Sr. Interventional Cardiologist, Apollo Hospitals, Chennai 600006, India.
authors.forename: P
authors.initials: P
authors.lastname: Ramachandran
mesh_terms: D000328:Adult; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000187:drug effects*; D006801:Humans; D007194:India; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000431:Ethanol
keywords: Alcohol septal ablation; Hypertrophic obstructive cardiomyopathy; Transcoronary alcohol ablation for septal hypertrophy (TASH)