Effect of Institutional Experience on Outcomes of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

Josef Veselka; Lothar Faber; Morten Kvistholm Jensen; Robert Cooper; Jaroslav Januska; Jan Krejci; Thomas Bartel; Maciej Dabrowski; Peter Riis Hansen; Vibeke Marie Almaas; Hubert Seggewiss; Dieter Horstkotte; Radka Adlova; Henning Bundgaard; Jurriën Ten Berg; Max Liebregts

doi:10.1016/j.cjca.2017.10.020

Effect of Institutional Experience on Outcomes of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

Josef Veselka, Lothar Faber, Morten Kvistholm Jensen, Robert Cooper, Jaroslav Januska, Jan Krejci, Thomas Bartel, Maciej Dabrowski, Peter Riis Hansen, Vibeke Marie Almaas, Hubert Seggewiss, Dieter Horstkotte, Radka Adlova, Henning Bundgaard, Jurriën Ten Berg, Max Liebregts

Institut for Klinisk Medicin

21 Citationer (Scopus)

Abstract

Background The current American College of Cardiology Foundation/American Heart Association guidelines on hypertrophic cardiomyopathy state that institutional experience is a key determinant of successful outcomes and lower complication rates of alcohol septal ablation (ASA). The aim of this study was to evaluate the safety and efficacy of ASA according to institutional experience with the procedure. Methods We retrospectively evaluated 1310 patients with symptomatic obstructive hypertrophic cardiomyopathy who underwent ASA and were divided into 2 groups. The first-50 group consisted of the first consecutive 50 patients treated at each centre, and the over-50 group consisted of patients treated thereafter (patients 51 and above). Results In the 30-day follow-up, there was a significant difference in the occurrence of major cardiovascular adverse events (21% in the first-50 group vs 12% in the over-50 group; P < 0.01), which was driven by the occurrence of cardiovascular deaths (2.1% vs 0.4%; P = 0.01) and implanted pacemakers (15% vs 9%; P < 0.01). In the long-term follow-up (5.5 ± 4.1 years), the first-50 group was associated with a significantly higher occurrence of major adverse events (P < 0.01) and higher cardiovascular mortality (P < 0.01). Also, patients in the first-50 group were more likely to self-report dyspnea of New York Heart Association class III/IV (16% vs 10%), to have a left ventricular outflow gradient > 30 mm Hg (16% vs 10%) at the last clinical check-up (P < 0.01 for both), and a probability of repeated septal reduction therapy (P = 0.03). Conclusions An institutional experience of > 50 ASA procedures was associated with a lower occurrence of ASA complications, better cardiovascular survival, better hemodynamic and clinical effect, and less need for repeated septal reduction therapy.

Originalsprog	Engelsk
Tidsskrift	Canadian Journal of Cardiology
Vol/bind	34
Udgave nummer	1
Sider (fra-til)	16-22
Antal sider	7
ISSN	0828-282X
DOI	https://doi.org/10.1016/j.cjca.2017.10.020
Status	Udgivet - jan. 2018

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10.1016/j.cjca.2017.10.020

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Veselka, J., Faber, L., Jensen, M. K., Cooper, R., Januska, J., Krejci, J., Bartel, T., Dabrowski, M., Hansen, P. R., Almaas, V. M., Seggewiss, H., Horstkotte, D., Adlova, R., Bundgaard, H., Ten Berg, J., & Liebregts, M. (2018). Effect of Institutional Experience on Outcomes of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy. Canadian Journal of Cardiology, 34(1), 16-22. https://doi.org/10.1016/j.cjca.2017.10.020

Veselka, J, Faber, L, Jensen, MK, Cooper, R, Januska, J, Krejci, J, Bartel, T, Dabrowski, M, Hansen, PR, Almaas, VM, Seggewiss, H, Horstkotte, D, Adlova, R, Bundgaard, H, Ten Berg, J & Liebregts, M 2018, 'Effect of Institutional Experience on Outcomes of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy', Canadian Journal of Cardiology, bind 34, nr. 1, s. 16-22. https://doi.org/10.1016/j.cjca.2017.10.020

@article{f6a83571324c4d04a8b824b563b7252e,

title = "Effect of Institutional Experience on Outcomes of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy",

abstract = "Background The current American College of Cardiology Foundation/American Heart Association guidelines on hypertrophic cardiomyopathy state that institutional experience is a key determinant of successful outcomes and lower complication rates of alcohol septal ablation (ASA). The aim of this study was to evaluate the safety and efficacy of ASA according to institutional experience with the procedure. Methods We retrospectively evaluated 1310 patients with symptomatic obstructive hypertrophic cardiomyopathy who underwent ASA and were divided into 2 groups. The first-50 group consisted of the first consecutive 50 patients treated at each centre, and the over-50 group consisted of patients treated thereafter (patients 51 and above). Results In the 30-day follow-up, there was a significant difference in the occurrence of major cardiovascular adverse events (21% in the first-50 group vs 12% in the over-50 group; P < 0.01), which was driven by the occurrence of cardiovascular deaths (2.1% vs 0.4%; P = 0.01) and implanted pacemakers (15% vs 9%; P < 0.01). In the long-term follow-up (5.5 ± 4.1 years), the first-50 group was associated with a significantly higher occurrence of major adverse events (P < 0.01) and higher cardiovascular mortality (P < 0.01). Also, patients in the first-50 group were more likely to self-report dyspnea of New York Heart Association class III/IV (16% vs 10%), to have a left ventricular outflow gradient > 30 mm Hg (16% vs 10%) at the last clinical check-up (P < 0.01 for both), and a probability of repeated septal reduction therapy (P = 0.03). Conclusions An institutional experience of > 50 ASA procedures was associated with a lower occurrence of ASA complications, better cardiovascular survival, better hemodynamic and clinical effect, and less need for repeated septal reduction therapy.",

keywords = "Ablation Techniques/adverse effects, Age Factors, Cardiac Output, Low, Cardiomyopathy, Hypertrophic/mortality, Cardiovascular Diseases/mortality, Dyspnea/etiology, Electric Countershock/statistics & numerical data, Ethanol/administration & dosage, Europe/epidemiology, Female, Heart Rate, Heart Septum/surgery, Humans, Male, Middle Aged, Pacemaker, Artificial/statistics & numerical data, Registries, Retreatment, Retrospective Studies, Stroke Volume",

author = "Josef Veselka and Lothar Faber and Jensen, {Morten Kvistholm} and Robert Cooper and Jaroslav Januska and Jan Krejci and Thomas Bartel and Maciej Dabrowski and Hansen, {Peter Riis} and Almaas, {Vibeke Marie} and Hubert Seggewiss and Dieter Horstkotte and Radka Adlova and Henning Bundgaard and {Ten Berg}, Jurri{\"e}n and Max Liebregts",

year = "2018",

month = jan,

doi = "10.1016/j.cjca.2017.10.020",

language = "English",

volume = "34",

pages = "16--22",

journal = "Canadian Journal of Cardiology",

issn = "0828-282X",

publisher = "Elsevier",

number = "1",

}

TY - JOUR

T1 - Effect of Institutional Experience on Outcomes of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

AU - Veselka, Josef

AU - Faber, Lothar

AU - Jensen, Morten Kvistholm

AU - Cooper, Robert

AU - Januska, Jaroslav

AU - Krejci, Jan

AU - Bartel, Thomas

AU - Dabrowski, Maciej

AU - Hansen, Peter Riis

AU - Almaas, Vibeke Marie

AU - Seggewiss, Hubert

AU - Horstkotte, Dieter

AU - Adlova, Radka

AU - Bundgaard, Henning

AU - Ten Berg, Jurriën

AU - Liebregts, Max

PY - 2018/1

Y1 - 2018/1

N2 - Background The current American College of Cardiology Foundation/American Heart Association guidelines on hypertrophic cardiomyopathy state that institutional experience is a key determinant of successful outcomes and lower complication rates of alcohol septal ablation (ASA). The aim of this study was to evaluate the safety and efficacy of ASA according to institutional experience with the procedure. Methods We retrospectively evaluated 1310 patients with symptomatic obstructive hypertrophic cardiomyopathy who underwent ASA and were divided into 2 groups. The first-50 group consisted of the first consecutive 50 patients treated at each centre, and the over-50 group consisted of patients treated thereafter (patients 51 and above). Results In the 30-day follow-up, there was a significant difference in the occurrence of major cardiovascular adverse events (21% in the first-50 group vs 12% in the over-50 group; P < 0.01), which was driven by the occurrence of cardiovascular deaths (2.1% vs 0.4%; P = 0.01) and implanted pacemakers (15% vs 9%; P < 0.01). In the long-term follow-up (5.5 ± 4.1 years), the first-50 group was associated with a significantly higher occurrence of major adverse events (P < 0.01) and higher cardiovascular mortality (P < 0.01). Also, patients in the first-50 group were more likely to self-report dyspnea of New York Heart Association class III/IV (16% vs 10%), to have a left ventricular outflow gradient > 30 mm Hg (16% vs 10%) at the last clinical check-up (P < 0.01 for both), and a probability of repeated septal reduction therapy (P = 0.03). Conclusions An institutional experience of > 50 ASA procedures was associated with a lower occurrence of ASA complications, better cardiovascular survival, better hemodynamic and clinical effect, and less need for repeated septal reduction therapy.

AB - Background The current American College of Cardiology Foundation/American Heart Association guidelines on hypertrophic cardiomyopathy state that institutional experience is a key determinant of successful outcomes and lower complication rates of alcohol septal ablation (ASA). The aim of this study was to evaluate the safety and efficacy of ASA according to institutional experience with the procedure. Methods We retrospectively evaluated 1310 patients with symptomatic obstructive hypertrophic cardiomyopathy who underwent ASA and were divided into 2 groups. The first-50 group consisted of the first consecutive 50 patients treated at each centre, and the over-50 group consisted of patients treated thereafter (patients 51 and above). Results In the 30-day follow-up, there was a significant difference in the occurrence of major cardiovascular adverse events (21% in the first-50 group vs 12% in the over-50 group; P < 0.01), which was driven by the occurrence of cardiovascular deaths (2.1% vs 0.4%; P = 0.01) and implanted pacemakers (15% vs 9%; P < 0.01). In the long-term follow-up (5.5 ± 4.1 years), the first-50 group was associated with a significantly higher occurrence of major adverse events (P < 0.01) and higher cardiovascular mortality (P < 0.01). Also, patients in the first-50 group were more likely to self-report dyspnea of New York Heart Association class III/IV (16% vs 10%), to have a left ventricular outflow gradient > 30 mm Hg (16% vs 10%) at the last clinical check-up (P < 0.01 for both), and a probability of repeated septal reduction therapy (P = 0.03). Conclusions An institutional experience of > 50 ASA procedures was associated with a lower occurrence of ASA complications, better cardiovascular survival, better hemodynamic and clinical effect, and less need for repeated septal reduction therapy.

KW - Ablation Techniques/adverse effects

KW - Age Factors

KW - Cardiac Output, Low

KW - Cardiomyopathy, Hypertrophic/mortality

KW - Cardiovascular Diseases/mortality

KW - Dyspnea/etiology

KW - Electric Countershock/statistics & numerical data

KW - Ethanol/administration & dosage

KW - Europe/epidemiology

KW - Female

KW - Heart Rate

KW - Heart Septum/surgery

KW - Humans

KW - Male

KW - Middle Aged

KW - Pacemaker, Artificial/statistics & numerical data

KW - Registries

KW - Retreatment

KW - Retrospective Studies

KW - Stroke Volume

U2 - 10.1016/j.cjca.2017.10.020

DO - 10.1016/j.cjca.2017.10.020

M3 - Journal article

C2 - 29275877

SN - 0828-282X

VL - 34

SP - 16

EP - 22

JO - Canadian Journal of Cardiology

JF - Canadian Journal of Cardiology

IS - 1

ER -

Effect of Institutional Experience on Outcomes of Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

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