BACKGROUND: The long-term efficacy and safety of alcohol septal ablation (ASA) in patients with highly symptomatic hypertrophic obstructive cardiomyopathy has been demonstrated. The aim of this study was to evaluate the long-term outcomes of mildly symptomatic patients with hypertrophic obstructive cardiomyopathy treated with ASA. METHODS AND RESULTS: We retrospectively evaluated consecutive patients enrolled in the Euro-ASA registry (1427 patients) and identified 161 patients (53±13 years; 27% women) who were mildly symptomatic (New York Heart Association [NYHA] class II) pre-ASA. The median (interquartile range) follow-up was 4.8 (1.7-8.5) years. The clinical outcome was assessed and compared with the age- and sex-matched general population. The 30-day mortality after ASA was 0.6% and the annual all-cause mortality rate was 1.7%, which was similar to the age- and sex-matched general population (P=0.62). A total of 141 (88%) patients had resting left ventricular outflow tract gradient at the last clinical checkup ≤30 mm Hg. Obstruction was reduced from 63±32 to 15±19 mm Hg (P<0.01), and the mean NYHA class decreased from 2.0±0 to 1.3±0.1 (P<0.01); 69%, 29%, and 2% of patients were in NYHA class I, II, and III at the last clinical checkup, respectively. CONCLUSIONS: Mildly symptomatic hypertrophic obstructive cardiomyopathy patients treated with ASA had sustained symptomatic and hemodynamic relief with a low risk of developing severe heart failure. Their survival is comparable to the general population.

1st Department of Internal Medicine Cardioangiology International Clinical Research Centre St Anne's University Hospital and Masaryk University Brno Czech Republic

Cardiocentre Podlesí Třinec Czech Republic

Cleveland Clinic Abu Dhabi Abu Dhabi United Arab Emirates

Department of Cardiology 2nd Medical School Charles University University Hospital Motol Prague Czech Republic

Department of Cardiology Gentofte Hospital Copenhagen University Hospital Hellerup Denmark

Department of Cardiology Heart and Diabetes Centre NRW Ruhr University Bochum Bad Oyenhausen Germany

Department of Cardiology Oslo University Hospital Oslo Norway

Department of Cardiology St Antonius Hospital Nieuwegein Nieuwegein the Netherlands

Department of Internal Medicine 3 Medical University Innsbruck Innsbruck Austria

Department of Internal Medicine Schweinfurt Germany

Department of Interventional Cardiology and Angiology Institute of Cardiology Warsaw Poland

Institute of Cardiovascular Medicine and Science Liverpool Heart and Chest Hospital Liverpool England

Unit for Inherited Cardiac Diseases Department of Cardiology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

J Am Heart Assoc. 2017 May 16;6(5):e006292. doi: 10.1161/JAHA.117.006292. PubMed

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