title: Long-term clinical follow-up of patients undergoing percutaneous alcohol septal reduction for symptomatic obstructive hypertrophic cardiomyopathy.
abstract: BACKGROUND
  Alcohol septal ablation (ASA) is an alternative treatment for symptomatic hypertrophic obstructive cardiomyopathy (HOCM) patients refractory to pharmacological therapy. We sought to evaluate the immediate and long-term incidence of death and changes in life quality in a consecutive cohort submitted to ASA.
  
  
  RESULTS
  Between October 1998 and December 2013, a total of 56 patients (mean age 53.2 ± 15.5) with symptomatic refractory HOCM were treated with ASA and followed during 15 years (mean 8 ± 4 years). There were 7 (12.5%) deaths, 2 (3.6%) being of cardiac cause. The Kaplan-Meier survival probability estimate was 96.4% at 1 year, 87.7 at 5 years and 81.0% at 12 years post-ASA. Significant improvement was observed in life quality assessed by DASI index and NYHA functional class as well as in the left ventricle outflow tract (LVOT) gradient reduction (from 92.8 ± 3.3 mm Hg to 9.37 ± 6.7 mm Hg, P < 0.001) and septum thickness (from 23.9 ± 0.6 mm to 12.9 ± 1.0 mm, P < 0.001). Only one patient (1.7%) required permanent pacemaker immediately after ASA. During follow-up, one patient had a repeated ASA, three patients underwent myectomy and other four required ICD/pacemaker. In the multivariate model only post-ASA LVOT residual gradient and left ventricle mass were associated with worse prognosis.
  
  
  CONCLUSIONS
  In this long-term clinical follow-up without losses, ASA was effective in improving quality of life and NYHA functional class, with relatively low mortality and very low need for immediate permanent pacemaker implantation. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Instituto Dante Pazzanese de Cardiologia - and - Hospital do Coração -Associação do Sanatório Sírio.
authors.forename: Silvia
authors.initials: S
authors.lastname: Fortunato de Cano
authors.affiliation: Instituto Dante Pazzanese de Cardiologia - and - Hospital do Coração -Associação do Sanatório Sírio.
authors.forename: Manuel
authors.initials: M
authors.lastname: Nicolas Cano
authors.affiliation: Instituto Dante Pazzanese de Cardiologia - and - Hospital do Coração -Associação do Sanatório Sírio.
authors.forename: José
authors.initials: J
authors.lastname: de Ribamar Costa
authors.forename: Jairo
authors.initials: J
authors.lastname: Alves Pinheiro
authors.affiliation: Instituto Dante Pazzanese de Cardiologia - and - Hospital do Coração -Associação do Sanatório Sírio.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Bellio de Mattos Barretto
authors.affiliation: Instituto Dante Pazzanese de Cardiologia - and - Hospital do Coração -Associação do Sanatório Sírio.
authors.forename: David
authors.initials: D
authors.lastname: Costa de Souza Le Bihan
authors.affiliation: Instituto Dante Pazzanese de Cardiologia - and - Hospital do Coração -Associação do Sanatório Sírio.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Abizaid
authors.affiliation: Instituto Dante Pazzanese de Cardiologia - and - Hospital do Coração -Associação do Sanatório Sírio.
authors.forename: Amanda
authors.initials: A
authors.lastname: Sousa
authors.affiliation: Instituto Dante Pazzanese de Cardiologia - and - Hospital do Coração -Associação do Sanatório Sírio.
authors.forename: J
authors.initials: J
authors.lastname: Eduardo Sousa
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D001938:Brazil / Q000453:epidemiology; D006328:Cardiac Catheterization / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D004452:Echocardiography; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000431:Ethanol
keywords: alcohol septal ablation; hypertrophic obstructive cardiomyopathy; left ventricle outflow tract obstruction; percutaneous intervention