Periprocedural, Short-Term, and Long-Term Outcomes of Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy: A 20-Year Single-Center Experience

Özet

Background: Alcohol septal ablation is recommended for hypertrophic obstructive car- diomyopathy patients who had refractory symptoms despite optimal medical treatment. We compared the periprocedural, short-, and long-term clinical outcomes and mortality predictors in hypertrophic obstructive cardiomyopathy patients who underwent alcohol septal ablation. Methods: Hypertrophic obstructive cardiomyopathy patients aged ≥18 years (63 females and 71 males) who underwent alcohol septal ablation were included. The primary end- point was all-cause mortality. Results: The mean patient age was 60.0 (standard deviation 13.7) years. The median fol- low-up time was 13 (7.6-18.5) years. During the procedure, 9, 2, and 1 patients developed ventricular fibrillation, remote site myocardial infarction, and pericardial tamponade, respectively, but none died. One patient died during hospitalization. During the long-term follow-up, 17, 5, 20, and 8 patients developed heart failure, myocardial infarction, chronic atrial fibrillation, and non-fatal stroke, respectively, and 24 died. There was no significant difference between the sexes (all P > .05). Age (hazard ratio = 0.69, 95% CI = 0.61‒0.78, P < .001), body mass index (hazard ratio = 1.20, 95% CI = 1.04-1.40, P = .01), age at diagnosis (hazard ratio = 1.57, 95% CI = 1.34-1.78, P < .001), and time from diagnosis to ablation (haz- ard ratio = 1.57, 95% CI = 1.35-1.84, P < .001) predicted all-cause mortality. In Kaplan‒Meier curves, long-term all-cause mortality was similar in men and women (P[log-rank] = .43). Conclusion: Alcohol septal ablation has similar short- and long-term outcomes for both sexes in hypertrophic obstructive cardiomyopathy patients. Risk factors for long- term mortality were age, body mass index, diagnosis age, and time delay to opera- tion. Therefore, alcohol septal ablation timing is essential for better clinical outcomes. Our findings may contribute to the increased performance of alcohol septal ablation in hypertrophic obstructive cardiomyopathy patients in our country.