title: Prevalence of Non-Left Anterior Descending Septal Perforator Culprit in Patients With Hypertrophic Cardiomyopathy Undergoing Alcohol Septal Ablation.
abstract: Identifying the coronary branch that supplies the basal septum is the cornerstone for successful alcohol septal ablation (ASA). The basal septum is often supplied by septal perforator artery/arteries (SPA/SPAs) not originating from the left anterior descending (LAD) coronary artery. We aim to investigate the prevalence and significance of non-LAD septal "culprit" in patients undergoing ASA. A retrospective review of patients who underwent ASA from 2006 to 2014 was conducted. Procedural and midterm outcomes of patients who had ASA of LAD and non-LAD culprit SPA were reported. A total 89 patients were included in the analysis; 13 patients (15%) had ASA of non-LAD SPA. These patients were more likely to have a history of failed ASA, more than one SPA treated, more ethanol dose injected, longer procedures, and higher contrast use compared with those who had ASA of LAD-SPA. In-hospital outcomes, residual gradient, symptom improvement, and midterm mortality were similar in the 2 groups. In conclusion, in a cohort of patients undergoing ASA, 15% had ablation of SPA culprit that did not originate from the LAD. Half of these patients had previous unsuccessful ASA. Systematic screening for the ideal culprit SPA with nonselective coronary injection of echo contrast should be used to avoid incomplete or failed ASA.
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, University of Rochester Medical Center, Rochester, New York. Electronic address: adnanalkhouli@gmail.com.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Alkhouli
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, University of Rochester Medical Center, Rochester, New York.
authors.forename: Waseem
authors.initials: W
authors.lastname: Sajjad
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, University of Rochester Medical Center, Rochester, New York.
authors.forename: Junsoo
authors.initials: J
authors.lastname: Lee
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, University of Rochester Medical Center, Rochester, New York.
authors.forename: Genaro
authors.initials: G
authors.lastname: Fernandez
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, University of Rochester Medical Center, Rochester, New York.
authors.forename: Bryan
authors.initials: B
authors.lastname: Waits
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, University of Rochester Medical Center, Rochester, New York.
authors.forename: Karl Q
authors.initials: KQ
authors.lastname: Schwarz
authors.affiliation: Division of Cardiovascular Disease, Department of Medicine, University of Rochester Medical Center, Rochester, New York.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Cove
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004452:Echocardiography; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D000431:Ethanol