Alcohol septal ablation (ASA) is an effective interventional therapeutic strategy to reduce or eliminate left ventricular outflow tract obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM). Although ASA was introduced 25 years ago, there are still no available guidelines to follow. Therefore, most interventional cardiologists rely on their own experience, which is often limited by a relatively low number of performed procedures. This paper presents ten tips and tricks to safe and effective ASA for HOCM.

• Keywords
• hypertrophic obstructive cardiomyopathy, obstruction, survival, tips and tricks,
• Publication type
• Journal Article MeSH
• Review MeSH

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.

• Keywords
• ablation, hypertrophic cardiomyopathy, outcome,
• MeSH
• Ablation Techniques * adverse effects   mortality   MeSH
• Time Factors MeSH
• Adult MeSH
• Ethanol administration & dosage   adverse effects   MeSH
• Ventricular Function, Left MeSH
• Cardiomyopathy, Hypertrophic diagnosis   mortality   physiopathology   surgery   MeSH
• Kaplan-Meier Estimate MeSH
• Middle Aged MeSH
• Humans MeSH
• Longitudinal Studies MeSH
• Recovery of Function MeSH
• Ventricular Outflow Obstruction diagnosis   mortality   physiopathology   surgery   MeSH
• Proportional Hazards Models MeSH
• Registries MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Severity of Illness Index MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe MeSH
• Names of Substances
• Ethanol MeSH

Hypertrophic cardiomyopathy (HCM) is characterized by the presence of increased thickness of the left ventricular wall that is not solely explained by abnormal loading conditions. Two-thirds of the patients with HCM have an obstruction in the left ventricle after provocation or even while at rest. This obstruction is associated with more symptoms and a worse prognosis. The two main therapeutic approaches for treating a left ventricular obstruction are alcohol septal ablation and surgical myectomy. Both these techniques are discussed in this article. Currently, the final decision concerning the optimal invasive therapy for patients with obstructive HCM must be individualized to each patient depending on his/her wishes and expectations, way of life, age, heart morphology, and hemodynamics, as well as the experience of the treating center.

• Keywords
• alcohol septal ablation, hypertrophic cardiomyopathy, surgical myectomy,
• Publication type
• Journal Article MeSH

INTRODUCTION: Nonpharmacological treatment of patients with hypertrophic obstructive cardiomyopathy (HOCM) comprises surgical myectomy (SME), alcohol septal ablation (ASA), and dual-chamber (DDD) pacing. The aim of the study was to compare the long-term effect of DDD pacing and ASA in symptomatic HOCM patients. PATIENTS AND METHODS: We evaluated retrospective data from three cardiocenters; there were 24 patients treated with DDD pacing included and 52 treated with ASA followed for 101 ± 49 and 87 ± 23 months, respectively. RESULTS: In the group treated with DDD pacing, the left ventricle outflow tract gradient (LVOTG) decreased from 82 ± 44 mmHg to 21 ± 21 mmHg, and NYHA class improved from 2.7 ± 0.5 to 2.1 ± 0.6 (both P < 0.001). In the ASA-treated group, a decline in LVOTG from 73 ± 38 mmHg to 24 ± 26 mmHg and reduction in NYHA class from 2.8 ± 0.5 to 1.7 ± 0.8 were observed (both P < 0.001). The LVOTG change was similar in both groups (P = 0.264), and symptoms were more affected by ASA (P = 0.001). CONCLUSION: ASA and DDD pacing were similarly effective in reducing LVOTG. The symptoms improvement was more expressed in patients treated with ASA.

• MeSH
• Echocardiography MeSH
• Ethanol therapeutic use   MeSH
• Cardiomyopathy, Hypertrophic diagnostic imaging   therapy   MeSH
• Combined Modality Therapy MeSH
• Middle Aged MeSH
• Humans MeSH
• Longitudinal Studies MeSH
• Retrospective Studies MeSH
• Sclerotherapy MeSH
• Sclerosing Solutions therapeutic use   MeSH
• Cardiac Resynchronization Therapy methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH
• Geographicals
• Czech Republic MeSH
• Names of Substances
• Ethanol MeSH
• Sclerosing Solutions MeSH

Echo-guided alcohol septal ablation (ASA) is an alternative treatment for highly symptomatic patients with obstructive hypertrophic cardiomyopathy (HOCM). Previous reports suggest that a low dose of alcohol (1.5-2 ml) is as effective as the classic dose (2-4 ml) used in the past. Because a larger infarct might be associated with a potential long-term risk, in this pilot study we wanted to determine whether an ultra-low dose of alcohol (1 ml) would be effective in the mid-term follow-up. Seventy patients (55+/-13 years, range 24-81 years, septum thickness <31 mm) with a highly symptomatic HOCM receiving maximum medical therapy were enrolled. Thirty-five consecutive patients (group I) have been treated with an ultra-low alcohol dose (1.0+/-0.1 ml) and compared with a control group II of 35 patients treated by the same medical team using the classic alcohol dose (2.5+/-0.8 ml) in the past. At 6-month follow-up, both groups of patients improved in dyspnea (2.9+/-0.6 vs 1.5+/-0.5 New York Heart Association [NYHA] class for group I; P<0.01, and 2.5+/-0.7 vs 1.4+/-0.4 NYHA class for group II; P<0.01) and angina (2.1+/-1 vs 0.6+/-0.8 Canadian Cardiovascular Society [CCS] class for group I; P<0.01, and 2.1+/-0.9 vs 0.7+/-0.7 CCS class for group II; P<0.01). There was a significant decrease in left ventricular (LV) ejection fraction (P<0.05), septum thickness (P<0.01), and LV outflow gradient (P<0.01) in both groups of patients. However, there was no significant difference with regard to the extent of symptomatic or echocardiographic changes and complications between both groups. These results suggest that the ultra-low dose of alcohol (1 ml) is still effective in the treatment of the majority of HOCM patients without extreme septum hypertrophy (<31 mm).

• MeSH
• Time Factors MeSH
• Adult MeSH
• Ethanol administration & dosage   MeSH
• Cardiomyopathy, Hypertrophic diagnostic imaging   physiopathology   therapy   MeSH
• Injections, Intralesional MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Myocardium MeSH
• Follow-Up Studies MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Cardiac Catheterization methods   MeSH
• Ultrasonography MeSH
• Treatment Outcome MeSH
• Dose-Response Relationship, Drug MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH
• Names of Substances
• Ethanol MeSH