title: Long-Term Outcome of Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy in the Young and the Elderly.
abstract: OBJECTIVE
  The aim of this study was to compare outcomes of alcohol septal ablation (ASA) in young and elderly patients with obstructive hypertrophic cardiomyopathy (HCM).
  
  
  BACKGROUND
  The American College of Cardiology Foundation/American Heart Association guidelines reserve ASA for elderly patients and patients with serious comorbidities. Information on long-term age-specific outcomes after ASA is scarce.
  
  
  METHODS
  This cohort study included 217 HCM patients (age 54 ± 12 years) who underwent ASA because of symptomatic left ventricular outflow tract obstruction. Patients were divided into young (age ≤55 years) and elderly (age >55 years) groups and matched by age in a 1:1 fashion to nonobstructive HCM patients.
  
  
  RESULTS
  Atrioventricular block following ASA was more common in elderly patients (43% vs. 21%; p = 0.001), resulting in pacemaker implantation in 13% and 5%, respectively (p = 0.06). Residual left ventricular outflow tract gradient, post-procedural New York Heart Association functional class, and necessity for additional septal reduction therapy was comparable between age groups. During a follow-up of 7.6 ± 4.6 years, 54 patients died. The 5- and 10-year survival following ASA was 95% and 90% in patients age ≤55 years and 93% and 82% in patients age >55 years, which was comparable to their control groups. The annual adverse arrhythmic event rate following ASA was 0.7%/year in young patients and 1.4%/year in elderly patients, which was comparable to their control groups.
  
  
  CONCLUSIONS
  ASA is similarly effective for reduction of symptoms in young and elderly patients; however, younger patients have a lower risk of procedure-related atrioventricular conduction disturbances. The long-term mortality rate and risk of adverse arrhythmic events following ASA are low, both in young and elderly patients, and are comparable to age-matched nonobstructive HCM patients.
authors.affiliation: Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands. Electronic address: maxliebregts@gmail.com.
authors.forename: Max
authors.initials: M
authors.lastname: Liebregts
authors.affiliation: Department of Cardiology, Martini Hospital, Groningen, the Netherlands.
authors.forename: Robbert C
authors.initials: RC
authors.lastname: Steggerda
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Pieter A
authors.initials: PA
authors.lastname: Vriesendorp
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Hannah
authors.initials: H
authors.lastname: van Velzen
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.affiliation: Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium.
authors.forename: Rik
authors.initials: R
authors.lastname: Willems
authors.affiliation: Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: van Cleemput
authors.affiliation: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Maarten P
authors.initials: MP
authors.lastname: van den Berg
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Michelle
authors.initials: M
authors.lastname: Michels
authors.affiliation: Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands.
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: ten Berg
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects / Q000401:mortality; D000328:Adult; D000367:Age Factors; D000368:Aged; D054537:Atrioventricular Block / Q000209:etiology / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D000431:Ethanol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010138:Pacemaker, Artificial; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000431:Ethanol
keywords: alcohol septal ablation; hypertrophic cardiomyopathy; septal reduction therapy