Outcomes of Alcohol Septal Ablation in Younger Patients With Obstructive Hypertrophic Cardiomyopathy

Max Liebregts; Lothar Faber; Morten K. Jensen; Pieter A. Vriesendorp; Jaroslav Januska; Jan Krejci; Peter R Hansen; Hubert Seggewiss; Dieter Horstkotte; Radka Adlova; Henning Bundgaard; Jurriën M. ten Berg; Josef Veselka

doi:10.1016/j.jcin.2017.03.030

Outcomes of Alcohol Septal Ablation in Younger Patients With Obstructive Hypertrophic Cardiomyopathy

Max Liebregts^*, Lothar Faber, Morten K. Jensen, Pieter A. Vriesendorp, Jaroslav Januska, Jan Krejci, Peter R Hansen, Hubert Seggewiss, Dieter Horstkotte, Radka Adlova, Henning Bundgaard, Jurriën M. ten Berg, Josef Veselka

^*Corresponding author for this work

Department of Clinical Medicine

31 Citations (Scopus)

Abstract

Objectives The aim of this study was to describe the safety and outcomes of alcohol septal ablation (ASA) in younger patients with obstructive hypertrophic cardiomyopathy. Background The American College of Cardiology Foundation/American Heart Association guidelines reserve ASA for older patients and patients with serious comorbidities. Data on long-term age-specific outcomes after ASA are scarce. Methods A total of 1,197 patients (mean age 58 ± 14 years) underwent ASA for obstructive hypertrophic cardiomyopathy. Patients were divided into young (≤50 years), middle-age (51 to 64 years), and older (≥65 years) groups. Results Thirty-day mortality and pacemaker implantation rates were lower in young compared with older patients (0.3% vs. 2% [p = 0.03] and 8% vs. 16% [p < 0.001], respectively). Ninety-five percent of young patients were in New York Heart Association functional class I or II at last follow-up. During a mean follow-up period of 5.4 ± 4.2 years, 165 patients (14%) died. Annual mortality rates of young, middle-age, and older patients were 1%, 2%, and 5%, respectively (p < 0.01). Annual adverse arrhythmic event rates were similar in the 3 age groups at about 1% (p = 0.90). Independent predictors of mortality in young patients were age, female sex, and residual left ventricular outflow tract gradient. Additionally, young patients treated with ≥2.5 ml alcohol had a higher all-cause mortality rate (0.6% vs. 1.4% per year in patients treated with <2.5 ml, p = 0.03). Conclusions ASA in younger patients with obstructive hypertrophic cardiomyopathy was safe and effective for relief of symptoms at long-term follow-up. The authors propose that the indication for ASA can be broadened to younger patients.

Original language	English
Journal	J A C C: Cardiovascular Interventions
Volume	10
Issue number	11
Pages (from-to)	1134-1143
ISSN	1936-8798
DOIs	https://doi.org/10.1016/j.jcin.2017.03.030
Publication status	Published - 2017

Keywords

alcohol septal ablation
hypertrophic cardiomyopathy
septal reduction therapy

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10.1016/j.jcin.2017.03.030

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Liebregts, M., Faber, L., Jensen, M. K., Vriesendorp, P. A., Januska, J., Krejci, J., Hansen, P. R., Seggewiss, H., Horstkotte, D., Adlova, R., Bundgaard, H., ten Berg, J. M., & Veselka, J. (2017). Outcomes of Alcohol Septal Ablation in Younger Patients With Obstructive Hypertrophic Cardiomyopathy. J A C C: Cardiovascular Interventions, 10(11), 1134-1143. https://doi.org/10.1016/j.jcin.2017.03.030

Liebregts, M, Faber, L, Jensen, MK, Vriesendorp, PA, Januska, J, Krejci, J, Hansen, PR, Seggewiss, H, Horstkotte, D, Adlova, R, Bundgaard, H, ten Berg, JM & Veselka, J 2017, 'Outcomes of Alcohol Septal Ablation in Younger Patients With Obstructive Hypertrophic Cardiomyopathy', J A C C: Cardiovascular Interventions, vol. 10, no. 11, pp. 1134-1143. https://doi.org/10.1016/j.jcin.2017.03.030

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title = "Outcomes of Alcohol Septal Ablation in Younger Patients With Obstructive Hypertrophic Cardiomyopathy",

abstract = "Objectives The aim of this study was to describe the safety and outcomes of alcohol septal ablation (ASA) in younger patients with obstructive hypertrophic cardiomyopathy. Background The American College of Cardiology Foundation/American Heart Association guidelines reserve ASA for older patients and patients with serious comorbidities. Data on long-term age-specific outcomes after ASA are scarce. Methods A total of 1,197 patients (mean age 58 ± 14 years) underwent ASA for obstructive hypertrophic cardiomyopathy. Patients were divided into young (≤50 years), middle-age (51 to 64 years), and older (≥65 years) groups. Results Thirty-day mortality and pacemaker implantation rates were lower in young compared with older patients (0.3% vs. 2% [p = 0.03] and 8% vs. 16% [p < 0.001], respectively). Ninety-five percent of young patients were in New York Heart Association functional class I or II at last follow-up. During a mean follow-up period of 5.4 ± 4.2 years, 165 patients (14%) died. Annual mortality rates of young, middle-age, and older patients were 1%, 2%, and 5%, respectively (p < 0.01). Annual adverse arrhythmic event rates were similar in the 3 age groups at about 1% (p = 0.90). Independent predictors of mortality in young patients were age, female sex, and residual left ventricular outflow tract gradient. Additionally, young patients treated with ≥2.5 ml alcohol had a higher all-cause mortality rate (0.6% vs. 1.4% per year in patients treated with <2.5 ml, p = 0.03). Conclusions ASA in younger patients with obstructive hypertrophic cardiomyopathy was safe and effective for relief of symptoms at long-term follow-up. The authors propose that the indication for ASA can be broadened to younger patients.",

keywords = "alcohol septal ablation, hypertrophic cardiomyopathy, septal reduction therapy",

author = "Max Liebregts and Lothar Faber and Jensen, {Morten K.} and Vriesendorp, {Pieter A.} and Jaroslav Januska and Jan Krejci and Hansen, {Peter R} and Hubert Seggewiss and Dieter Horstkotte and Radka Adlova and Henning Bundgaard and {ten Berg}, {Jurri{\"e}n M.} and Josef Veselka",

year = "2017",

doi = "10.1016/j.jcin.2017.03.030",

language = "English",

volume = "10",

pages = "1134--1143",

journal = "J A C C: Cardiovascular Interventions",

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TY - JOUR

T1 - Outcomes of Alcohol Septal Ablation in Younger Patients With Obstructive Hypertrophic Cardiomyopathy

AU - Liebregts, Max

AU - Faber, Lothar

AU - Jensen, Morten K.

AU - Vriesendorp, Pieter A.

AU - Januska, Jaroslav

AU - Krejci, Jan

AU - Hansen, Peter R

AU - Seggewiss, Hubert

AU - Horstkotte, Dieter

AU - Adlova, Radka

AU - Bundgaard, Henning

AU - ten Berg, Jurriën M.

AU - Veselka, Josef

PY - 2017

Y1 - 2017

N2 - Objectives The aim of this study was to describe the safety and outcomes of alcohol septal ablation (ASA) in younger patients with obstructive hypertrophic cardiomyopathy. Background The American College of Cardiology Foundation/American Heart Association guidelines reserve ASA for older patients and patients with serious comorbidities. Data on long-term age-specific outcomes after ASA are scarce. Methods A total of 1,197 patients (mean age 58 ± 14 years) underwent ASA for obstructive hypertrophic cardiomyopathy. Patients were divided into young (≤50 years), middle-age (51 to 64 years), and older (≥65 years) groups. Results Thirty-day mortality and pacemaker implantation rates were lower in young compared with older patients (0.3% vs. 2% [p = 0.03] and 8% vs. 16% [p < 0.001], respectively). Ninety-five percent of young patients were in New York Heart Association functional class I or II at last follow-up. During a mean follow-up period of 5.4 ± 4.2 years, 165 patients (14%) died. Annual mortality rates of young, middle-age, and older patients were 1%, 2%, and 5%, respectively (p < 0.01). Annual adverse arrhythmic event rates were similar in the 3 age groups at about 1% (p = 0.90). Independent predictors of mortality in young patients were age, female sex, and residual left ventricular outflow tract gradient. Additionally, young patients treated with ≥2.5 ml alcohol had a higher all-cause mortality rate (0.6% vs. 1.4% per year in patients treated with <2.5 ml, p = 0.03). Conclusions ASA in younger patients with obstructive hypertrophic cardiomyopathy was safe and effective for relief of symptoms at long-term follow-up. The authors propose that the indication for ASA can be broadened to younger patients.

AB - Objectives The aim of this study was to describe the safety and outcomes of alcohol septal ablation (ASA) in younger patients with obstructive hypertrophic cardiomyopathy. Background The American College of Cardiology Foundation/American Heart Association guidelines reserve ASA for older patients and patients with serious comorbidities. Data on long-term age-specific outcomes after ASA are scarce. Methods A total of 1,197 patients (mean age 58 ± 14 years) underwent ASA for obstructive hypertrophic cardiomyopathy. Patients were divided into young (≤50 years), middle-age (51 to 64 years), and older (≥65 years) groups. Results Thirty-day mortality and pacemaker implantation rates were lower in young compared with older patients (0.3% vs. 2% [p = 0.03] and 8% vs. 16% [p < 0.001], respectively). Ninety-five percent of young patients were in New York Heart Association functional class I or II at last follow-up. During a mean follow-up period of 5.4 ± 4.2 years, 165 patients (14%) died. Annual mortality rates of young, middle-age, and older patients were 1%, 2%, and 5%, respectively (p < 0.01). Annual adverse arrhythmic event rates were similar in the 3 age groups at about 1% (p = 0.90). Independent predictors of mortality in young patients were age, female sex, and residual left ventricular outflow tract gradient. Additionally, young patients treated with ≥2.5 ml alcohol had a higher all-cause mortality rate (0.6% vs. 1.4% per year in patients treated with <2.5 ml, p = 0.03). Conclusions ASA in younger patients with obstructive hypertrophic cardiomyopathy was safe and effective for relief of symptoms at long-term follow-up. The authors propose that the indication for ASA can be broadened to younger patients.

KW - alcohol septal ablation

KW - hypertrophic cardiomyopathy

KW - septal reduction therapy

U2 - 10.1016/j.jcin.2017.03.030

DO - 10.1016/j.jcin.2017.03.030

M3 - Journal article

C2 - 28595881

AN - SCOPUS:85020231314

SN - 1936-8798

VL - 10

SP - 1134

EP - 1143

JO - J A C C: Cardiovascular Interventions

JF - J A C C: Cardiovascular Interventions

IS - 11

ER -

Outcomes of Alcohol Septal Ablation in Younger Patients With Obstructive Hypertrophic Cardiomyopathy

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Keywords

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