Alcohol septal ablation reduced LVOT gradient from 72.0 to 20.9 mmHg with 99.6% success and 0.16% 30-day mortality; females had 2.75x higher risk for pacemaker.
Does alcohol septal ablation effectively reduce LVOT gradients and what are the safety outcomes in patients with obstructive hypertrophic cardiomyopathy?
Alcohol septal ablation is highly effective at reducing LVOT gradients in Japanese patients with HOCM, though female patients face a significantly higher risk of requiring a permanent pacemaker for high-grade heart block.
Absolute Event Rate: 0% vs 0%
Abstract Background Recent advancements in coronary CT and MRI have facilitated preoperative risk evaluation and procedural planning for alcohol septal ablation (ASA) in symptomatic obstructive hypertrophic cardiomyopathy (HOCM). However, there are limited reports on the current status and outcomes of ASA in Japan. Method A total of 634 patients who underwent ASA in 72 participating hospitals in Japan between January 2019 and December 2022 were extracted from the J-SHD, which is a nationwide, prospective registry in Japan. Characteristics, clinical presentation, procedural details, and in-hospital outcomes were analyzed. Multivariate logistic regression modeling was used to assess prognostic factors for procedural success and pacemaker implantation after ASA. Results Female gender was dominant (76.5%, n=485) in the cohort. The mean procedure time was 168±52 minutes. The volumes of injected alcohol during ASA were 3.0 ± 1.8ml. Successful alcohol injection was achieved in 99.6% (629/634) of the patients. ASA had reduced left ventricular outflow tract (LVOT) gradient from 72.0 ± 44.0 to 20.9 ± 24.6 mmHg (P0.001). The 30-day mortality was 0.16% (1/634). Ventricular arrhythmia occurred in 4 patients (0.63%) and permanent high-grade heart block occurred in 50 patients (7.9%) who received a permanent pacemaker. Multivariate analyses showed that higher pre LVOT gradient was significantly associated with a successful 50% reduction in LVOT gradient (Odds ratio=1.05, 95% CI 1.01 to 1.10, P=0.025 per 10mmHg increase). Female gender was detected as the independent predictor for high-grade heart block needing permanent pacemaker (Odds ratio=2.75, 95% CI 1.04 to 7.23, P=0.041). Conclusions A nationwide Japanese registry (J-SHD) demonstrated safety and efficacy of ASA for HOCM in Japan. Female gender could be a potential risk for high-grade heart block after ASA.
Yamaguchi et al. (Sat,) reported a other. Alcohol septal ablation reduced LVOT gradient from 72.0 to 20.9 mmHg with 99.6% success and 0.16% 30-day mortality; females had 2.75x higher risk for pacemaker.