Clinical question: Is alcohol septal ablation (ASA) safe in younger patients with obstructive hypertrophic cardiomyopathy (HCM)?
Background: ASA is a class III recommendation for younger patients when myectomy is a viable option. This recommendation was based on the lack of evidence for younger patients whereas myectomy already was proven to be safe and effective.
Dr. Noppon Setji
Study design: International multicenter observational cohort design.
Setting: 7 tertiary centers from 4 European countries during 1996-2015.
Synopsis: With 1,200 patients, this was the largest ASA cohort to date. The cohort was divided into three groups: young (less than 50 years), middle age (51-65 years), and old (greater than 65 years). During the periprocedural period, young patients had better outcomes than did older patients in regards to complete heart block, cardiac tamponade, and mortality. After 5.4 years of follow-up, young patients had favorable outcomes for long-term survival after ASA and comparable rates of adverse antiarrhythmic events; 95% of these young patients were functioning in NYHA class I or II at follow-up. These young patients also had half the risk of permanent pacemaker implantation, compared with older patients. In an analysis of very young patients (younger than 35 years), ASA appeared to be safe and effective as well. Additionally, young patients who were treated with more than 2.5 mL alcohol had higher all-cause mortality, compared with patients who were treated with less than 2.5 mL.
Bottom line: For patients aged 50 years or less with HCM, ASA and surgical myectomy are both safe and effective for relief of symptoms.
Citation: Liebregts M et al. Outcomes of alcohol septal ablation in younger patients with obstructive hypertrophic cardiomyopathy. JACC: Cardiovascular Interventions. Jun 2017:1134-43.
Dr. Setji is a hospitalist and medical director, Duke University Hospital.