title: Computed tomography angiography planning identifies the target vessel for optimum infarct location and improves clinical outcome in alcohol septal ablation for hypertrophic obstructive cardiomyopathy.
abstract: OBJECTIVE
  Alcohol septal ablation (ASA) is an established treatment option in hypertrophic obstructive cardiomyopathy (HOCM). ASA is ineffective in some: inaccurate infarct and inability to identify a vessel contribute. We aimed to improve accuracy of infarct using CT angiography guidance and provide a more predictable and satisfactory outcome.
  
  
  RESULTS
  Twenty-one successive patients with symptomatic LVOT obstruction refractory to medication underwent CT angiography planning to guide ASA. CT was performed using a dual-source CT system. Alcohol was delivered to the artery identified from CT: in 17/21 this was a sub-branch of a septal artery, in 2/21 the septal vessel was identified from the circumflex artery. Peak gradient improved from 98 (IQR 89.50-111.50) mmHg to 14 (IQR 8.50-22) mmHg (p=0.003). Systolic anterior motion (SAM) improved in 18/20 patients. NYHA class improved by ≥1 in 18/20. Peak VO2 improved from 79.19% of predicted value (±14.01) to 91.62% (±12.02) predicted (p<0.0001). Success at the first procedure is greater with CT guidance, 17/20 vs. 50/75 with traditional methods (pre-CT guidance) (p=0.02); 9/20 had six-month CMR with target septum infarct in all. ASA-related RBBB reduced from 62% to 13% (p=0.0004).
  
  
  CONCLUSIONS
  CT angiography planning improves localisation of infarct and procedural success at the first attempt in ASA when compared to traditional methods. Follow-up to six months suggests a symptomatic, functional and haemodynamic improvement.
authors.affiliation: Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Cooper
authors.forename: Sukumaran R
authors.initials: SR
authors.lastname: Binukrishnan
authors.forename: Adeel
authors.initials: A
authors.lastname: Shahzad
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hasleton
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sigwart
authors.forename: Rodney H
authors.initials: RH
authors.lastname: Stables
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D000328:Adult; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D000072226:Computed Tomography Angiography / Q000379:methods*; D004452:Echocardiography; D000431:Ethanol / Q000008:administration & dosage*; D005080:Exercise Test; D005260:Female; D006346:Heart Septum / Q000601:surgery*; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging
chemical_list: D000431:Ethanol