Effectiveness and safety beyond 10 years of percutaneous transluminal septal ablation in hypertrophic obstructive cardiomyopathy.
OBJECTIVE
Percutaneous transluminal septal ablation is an alternative treatment in patients with hypertrophic obstructive cardiomyopathy. However, due to the relatively new introduction of this technique, there is no information on its very long term results (>10 years).


METHODS
The present study included consecutive patients treated in 5 centers between 1998 and 2003. We analyzed clinical, hemodynamic, and echocardiographic data at baseline and follow-up.


RESULTS
A total of 45 patients were included; there were 31 (69%) women, the mean age was 62.4 (14) years, and 39 patients (86.6%) showed functional class III or IV. Septal thickness was 21.8 (3.5) mm, the peak resting gradient on echocardiography was 77 (39) mmHg, and mitral regurgitation was at least moderate in 22 patients (48.8%). During hospitalization, permanent pacemaker implantation was required in 3 patients and ventricular perforation (by pacing lead) occurred in 1 patient, requiring surgery. After a follow-up of 12.3 years (11.0-13.5 years), 2 patients (4.4%) died from cardiac causes (heart failure and posttransplantation), 3 patients required an implantable cardioverter-defibrillator (1 for primary prevention and 2 due to sustained ventricular tachycardia after cardiac surgery), and 2 underwent cardiac surgery (due to endocarditis and mitral regurgitation). In the last clinical review, functional class was I-II in 39 patients (86.6%) (P<.0001), the peak resting gradient was 16 (23) mmHg (P<.0001), and mitral regurgitation was absent or mild in 34 patients (75.5%) (P<.03).


CONCLUSIONS
The results of this study suggest that septal ablation is safe and effective in the very long term. The procedure was not associated with a significant incidence of sudden death or symptomatic ventricular arrhythmias.
Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain. Electronic address: he1thj@humv.es.
José M
JM
de la Torre Hernandez
Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Monica
M
Masotti Centol
Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Piedad
P
Lerena Saenz
Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
Ángel
Á
Sánchez Recalde
Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Federico
F
Gimeno de Carlos
Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
Pablo
P
Piñón Esteban
Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Diego
D
Fernandez Rodriguez
Sección de Imagen Cardiaca, Servicio de Cardiología, Institut del Tórax, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
Marta
M
Sitges Carreño
Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Institut del Tórax, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Manel
M
Sabate Tenas
Unidad de Hemodinámica y Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Javier
J
Zueco Gil
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014463:Ultrasonography
Ablación septal con catéter; Arritmias ventriculares; Catheter septal ablation; Hypertrophic cardiomyopathy; Miocardiopatía hipertrófica; Ventricular arrhythmia