title: Risk and Causes of Death in Patients After Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy.
abstract: BACKGROUND
  Because the final myocardial scar might be theoretically associated with an increased risk of sudden cardiac death, the long-term clinical course of patients who undergo alcohol septal ablation (ASA) is still a matter of debate. In this retrospective multicentre study, we report outcomes after ASA, including survival, analysis of causes of deaths, and association between time and cause of death.
  
  
  METHODS
  We enrolled 366 consecutive patients (58 ± 12 years, 54% women) who were treated using ASA and followed-up for 5.1 ± 4.5 years.
  
  
  RESULTS
  The in-hospital and 30-day mortality were 0.5% and 0.8%, respectively; the ASA-related morbidity was < 20%. Overall, 52 patients died during 1867 patient-years, which means the all-cause mortality rate was 2.8% per year. The mortality rates of sudden death and sudden death with an appropriate implantable cardioverter-defibrillator (ICD) discharge were 0.4% and 1% per year, respectively. Patients with sudden death or appropriate ICD discharge experienced these mortality events at younger age than patients who died of other hypertrophic obstructive cardiomyopathy-related causes (60.8 years [range, 52-71.5 years] vs 72.4 years [range, 64.2-75.2 years]; P = 0.048). A total of 292 patients (80%) had an outflow gradient ≤ 30 mm Hg, and 327 patients (89%) were in New York Heart Association class ≤ II at the last clinical check-up.
  
  
  CONCLUSIONS
  ASA had low procedure-related mortality, with subsequent 1% occurrence of sudden mortality events per year and 2.8% mortality rate per year in the long-term follow-up. Patients with sudden death or ICD discharge experienced the mortality events approximately 1 decade earlier than patients who died from other causes not related to hypertrophic cardiomyopathy.
authors.affiliation: Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic. Electronic address: veselka.josef@seznam.cz.
authors.forename: Josef
authors.initials: J
authors.lastname: Veselka
authors.affiliation: Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic.
authors.forename: David
authors.initials: D
authors.lastname: Zemánek
authors.affiliation: Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic.
authors.forename: Denisa
authors.initials: D
authors.lastname: Jahnlová
authors.affiliation: 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Center, St Anne's University Hospital and Masaryk University, Brno, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Krejčí
authors.affiliation: Cardiocentre Podlesí, Třinec, Czech Republic.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Januška
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Dabrowski
authors.affiliation: Department of Internal Medicine III, Medical University Innsbruck, Austria and Cleveland Clinic, Abu Dhabi, United Arab Emirates.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bartel
authors.affiliation: Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic.
authors.forename: Pavol
authors.initials: P
authors.lastname: Tomašov
mesh_terms: D000368:Aged; D000438:Alcohols / Q000627:therapeutic use*; D001317:Austria / Q000453:epidemiology; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D002423:Cause of Death; D002921:Cicatrix / Q000209:etiology / Q000401:mortality / Q000473:pathology; D018153:Czech Republic / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000379:methods / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011044:Poland / Q000453:epidemiology; D012597:Sclerosing Solutions / Q000627:therapeutic use; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000438:Alcohols; D012597:Sclerosing Solutions