title: Safety and efficacy of coil embolization of the septal perforator for septal ablation in patients with hypertrophic obstructive cardiomyopathy.
abstract: OBJECTIVE
  The objective of this study was to evaluate safety, efficacy, and durability of coil embolization of the major septal perforator of the left anterior descending coronary artery in patients with hypertrophic obstructive cardiomyopathy (HOCM).
  
  
  BACKGROUND
  The long-term effect of coil embolization therapy in HOCM patients is not well defined.
  
  
  METHODS
  We evaluated 24 symptomatic HOCM patients in a single center who underwent coil embolization of the septal perforator artery(ies).
  
  
  RESULTS
  Twenty-four patients on optimal medical therapy presented with NYHA functional class III (75%) or IV (25%) underwent the procedure. The procedure was successful in 22 patients, with significant reduction in left ventricular outflow tract (LVOT) gradient. The functional class significantly improved to class I (54.2%) or II (41.7%) (P < = 0.01). The LVOT gradient was significantly lower during follow up echocardiography (21.3 ± 19 vs. 81.3 ± 41 mm Hg; P < = 0.01). Interventricular septal thickness decreased over time (16.3 ± 3 vs. 18.5 ± 2 mm, P< = 0.01). The procedure was aborted in one of the patients after the third coil prolapsed from the septal perforator in to the left anterior descending artery. The coil was effectively snared out. Three patients required additional coil placement in the second major septal perforator. New permanent pacemaker placement was required in one patient. However, three patients underwent ICD implantation at follow up due to ventricular arrhythmias.
  
  
  CONCLUSIONS
  The results of this study suggest that the use of coil embolization for septal ablation is safe, effective, and durable in patients with symptomatic HOCM. © 2016 Wiley Periodicals, Inc.
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston and Memorial Hermann Heart and Vascular Institute, Houston, Texas, US.
authors: Israel
authors: I
authors: Guerrero
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston and Memorial Hermann Heart and Vascular Institute, Houston, Texas, US.
authors: Abhijeet
authors: A
authors: Dhoble
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston and Memorial Hermann Heart and Vascular Institute, Houston, Texas, US.
authors: Mark
authors: M
authors: Fasulo
authors: Medicine-Cardiology, Baylor College of Medicine, Houston, Texas, US.
authors: Ali E
authors: AE
authors: Denktas
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston and Memorial Hermann Heart and Vascular Institute, Houston, Texas, US.
authors: Shehzad
authors: S
authors: Sami
authors: Clinical and Translational Sciences, Department of Internal Medicine, Houston, Texas, US.
authors: Sangbum
authors: S
authors: Choi
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston and Memorial Hermann Heart and Vascular Institute, Houston, Texas, US.
authors: Prakash
authors: P
authors: Balan
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston and Memorial Hermann Heart and Vascular Institute, Houston, Texas, US.
authors: Salman A
authors: SA
authors: Arain
authors: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston and Memorial Hermann Heart and Vascular Institute, Houston, Texas, US.
authors: Richard W
authors: RW
authors: Smalling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D004452:Echocardiography; D004621:Embolization, Therapeutic / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
keywords: alcohol septal ablation; coil embolization; hypertrophic obstructive cardiomyopathy; myectomy