title: Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry.
abstract: The first cases of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) were published two decades ago. Although the outcomes of single-centre and national ASA registries have been published, the long-term survival and clinical outcome of the procedure are still debated.
  
  
  
  We report long-term outcomes from the as yet largest multinational ASA registry (the Euro-ASA registry). A total of 1275 (58 ± 14 years, median follow-up 5.7 years) highly symptomatic patients treated with ASA were included. The 30-day post-ASA mortality was 1%. Overall, 171 (13%) patients died during follow-up, corresponding to a post-ASA all-cause mortality rate of 2.42 deaths per 100 patient-years. Survival rates at 1, 5, and 10 years after ASA were 98% (95% CI 96-98%), 89% (95% CI 87-91%), and 77% (95% CI 73-80%), respectively. In multivariable analysis, independent predictors of all-cause mortality were age at ASA (P < 0.01), septum thickness before ASA (P < 0.01), NYHA class before ASA (P = 0.047), and the left ventricular (LV) outflow tract gradient at the last clinical check-up (P = 0.048). Alcohol septal ablation reduced the LV outflow tract gradient from 67 ± 36 to 16 ± 21 mmHg (P < 0.01) and NYHA class from 2.9 ± 0.5 to 1.6 ± 0.7 (P < 0.01). At the last check-up, 89% of patients reported dyspnoea of NYHA class ≤2, which was independently associated with LV outflow tract gradient (P < 0.01).
  
  
  
  The Euro-ASA registry demonstrated low peri-procedural and long-term mortality after ASA. This intervention provided durable relief of symptoms and a reduction of LV outflow tract obstruction in selected and highly symptomatic patients with obstructive HCM. As the post-procedural obstruction seems to be associated with both worse functional status and prognosis, optimal therapy should be focused on the elimination of LV outflow tract gradient.
authors.affiliation: Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Vúvalu 84, Prague5, Czech Republic veselka.josef@seznam.cz josef.veselka@fnmotol.cz.
authors.forename: Josef
authors.initials: J
authors.lastname: Veselka
authors.affiliation: Unit for Inherited Cardiac Diseases, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Morten Kvistholm
authors.initials: MK
authors.lastname: Jensen
authors.affiliation: Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands.
authors.forename: Max
authors.initials: M
authors.lastname: Liebregts
authors.affiliation: Cardiocentre Podlesí, Třinec, Czech Republic.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Januska
authors.affiliation: 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Centre, St. Anne's University Hospital and Masaryk University, Brno, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Krejci
authors.affiliation: Department of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria Cleveland Clinic, Abu Dhabi, United Arab Emirates.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bartel
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 Cardiology, Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark.
authors.forename: Peter Riis
authors.initials: PR
authors.lastname: Hansen
authors.affiliation: Department of Cardiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Vibeke Marie
authors.initials: VM
authors.lastname: Almaas
authors.affiliation: Department of Cardiology, Heart and Diabetes Centre NRW, Ruhr-University Bochum, Bad Oyenhausen, Germany Department of Internal Medicine, Schweinfurt, Germany.
authors.forename: Hubert
authors.initials: H
authors.lastname: Seggewiss
authors.affiliation: Department of Cardiology, Heart and Diabetes Centre NRW, Ruhr-University Bochum, Bad Oyenhausen, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Horstkotte
authors.affiliation: Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Vúvalu 84, Prague5, Czech Republic.
authors.forename: Pavol
authors.initials: P
authors.lastname: Tomasov
authors.affiliation: Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Vúvalu 84, Prague5, Czech Republic.
authors.forename: Radka
authors.initials: R
authors.lastname: Adlova
authors.affiliation: Unit for Inherited Cardiac Diseases, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Henning
authors.initials: H
authors.lastname: Bundgaard
authors.affiliation: Department of Cardiology, Martini Hospital, Groningen, the Netherlands.
authors.forename: Robbert
authors.initials: R
authors.lastname: Steggerda
authors.affiliation: Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands.
authors.forename: Jurriën
authors.initials: J
authors.lastname: Ten Berg
authors.affiliation: Department of Cardiology, Heart and Diabetes Centre NRW, Ruhr-University Bochum, Bad Oyenhausen, Germany.
authors.forename: Lothar
authors.initials: L
authors.lastname: Faber
mesh_terms: D055011:Ablation Techniques / Q000379:methods / Q000401:mortality; D002312:Cardiomyopathy, Hypertrophic / Q000401:mortality / Q000628:therapy*; D018572:Disease-Free Survival; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006346:Heart Septum; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012997:Solvents / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D012997:Solvents; D000431:Ethanol
keywords: Alcohol septal ablation; Prognosis; Survival