Long-Term Outcome of Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy in the Young and the Elderly

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• 作者：Max Liebregts ; MD^a ; ^{maxliebregts@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Robbert C. Steggerda ; MD^b ; Pieter A. Vriesendorp ; MD^c ; Hannah van Velzen ; MD^c ; Arend F.L. Schinkel ; MD ; PhD^c ; Rik Willems ; MD ; PhD^d ; Johan van Cleemput ; MD ; PhD^d ; Maarten P. van den Berg ; MD ; PhD^e ; Michelle Michels ; MD ; PhD^c ; Jurrië ; n M. ten Berg ; MD ; PhD^a
• 关键词：alcohol septal ablation ; hypertrophic cardiomyopathy ; septal reduction therapy
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：14 March 2016
• 年：2016
• 卷：9
• 期：5
• 页码：463-469
• 全文大小：325 K

文摘

The aim of this study was to compare outcomes of alcohol septal ablation (ASA) in young and elderly patients with obstructive hypertrophic cardiomyopathy (HCM).

Background

The American College of Cardiology Foundation/American Heart Association guidelines reserve ASA for elderly patients and patients with serious comorbidities. Information on long-term age-specific outcomes after ASA is scarce.

Methods

This cohort study included 217 HCM patients (age 54 ± 12 years) who underwent ASA because of symptomatic left ventricular outflow tract obstruction. Patients were divided into young (age ≤55 years) and elderly (age >55 years) groups and matched by age in a 1:1 fashion to nonobstructive HCM patients.

Results

Atrioventricular block following ASA was more common in elderly patients (43% vs. 21%; p = 0.001), resulting in pacemaker implantation in 13% and 5%, respectively (p = 0.06). Residual left ventricular outflow tract gradient, post-procedural New York Heart Association functional class, and necessity for additional septal reduction therapy was comparable between age groups. During a follow-up of 7.6 ± 4.6 years, 54 patients died. The 5- and 10-year survival following ASA was 95% and 90% in patients age ≤55 years and 93% and 82% in patients age >55 years, which was comparable to their control groups. The annual adverse arrhythmic event rate following ASA was 0.7%/year in young patients and 1.4%/year in elderly patients, which was comparable to their control groups.

Conclusions

ASA is similarly effective for reduction of symptoms in young and elderly patients; however, younger patients have a lower risk of procedure-related atrioventricular conduction disturbances. The long-term mortality rate and risk of adverse arrhythmic events following ASA are low, both in young and elderly patients, and are comparable to age-matched nonobstructive HCM patients.