Utility of preprocedural multidetector computed tomography in alcohol septal ablation for hypertrophic obstructive cardiomyopathy

  • Takashi Yanagiuchi
  • Norio TadaEmail author
  • Yoshihiro Haga
  • Shinichi Suzuki
  • Mie Sakurai
  • Masataka Taguri
  • Tatsushi Ootomo
Original Article


Preprocedural computed tomography (CT) imaging appears to provide an advantage in localization of the appropriate septal branch targeted for alcohol septal ablation (ASA). The objective of this study was to compare the clinical backgrounds, procedural characteristics, and outcomes of patients who underwent ASA with preprocedural CT assessment against those without CT assessment. Thirty consecutive patients with obstructive hypertrophic cardiomyopathy who underwent ASA were retrospectively included. Patients who underwent preprocedural CT (CT-guided ASA group, n = 11) were compared with patients who underwent ASA without CT (traditional ASA group, n = 19). The CT-guided ASA group had a significantly lower number of approached target vessels (1 [interquartile range {IQR}, 1–2] vs. 2 [IQR, 2–3], P = 0.036) and non-ablated target vessels (0 [IQR, 0–1] vs. 1 [IQR, 0–2], P = 0.031) than the traditional ASA group. There were no differences between the two groups in total fluoroscopy time, the amount of delivered radiation dose, and the volume of contrast medium used during the procedures. There were also no differences between the two groups in procedural success rate and improvement of left ventricular outflow tract gradient and New York Heart Association functional class at 1 month follow-up. CT had a significant impact on the ASA procedure diminishing the number of target vessels, and could be a reliable assessment modality to build its procedural strategy.


Alcohol septal ablation Computed tomography Hypertrophic cardiomyopathy Left ventricle outflow tract obstruction 



  1. 1.
    Agarwal S, Tuzcu EM, Desai MY, Smedira N, Lever HM, Lytle BW, et al. Updated meta-analysis of septal alcohol ablation versus myectomy for hypertrophic cardiomyopathy. J Am Coll Cardiol. 2010;55:823–34.CrossRefPubMedGoogle Scholar
  2. 2.
    Alam M, Dokainish H, Lakkis NM. Hypertrophic obstructive cardiomyopathy-alcohol septal ablation vs. myectomy: a meta-analysis. Eur Heart J. 2009;30:1080–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Sorajja P, Ommen SR, Homes DR Jr, Dearani JA, Rihal CS, Gersh BJ, et al. Survival after alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Circulation. 2012;126:2374–80.CrossRefPubMedGoogle Scholar
  4. 4.
    Leonardi RA, Kransdorf EP, Simel DL, Wang A. Meta-analysis of septal reduction therapies for obstructive hypertrophic cardiomyopathy. Comparative rates of overall mortality and sudden cardiac death after treatment. Circ Cardiovasc Interv. 2010;3:97–104.CrossRefPubMedGoogle Scholar
  5. 5.
    Jensen MK, Prinz C, Horsthotte D, van Buuren F, Bitter T, Faber L, et al. Alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy: low incidence of sudden cardiac death and reduced risk profile. Heart. 2013;99:1012–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Yoerger DM, Picard MH, Palacios IF, Vlahakes GJ, Lowry PA, Fifer MA. Time course of pressure gradient response after first alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Am J Cardiol. 2006;97:1511–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Chang SM, Lakkis NM, Franklin J, Spencer WH 3rd, Nagueh SF. Predictors of outcome after alcohol septal ablation therapy in patients with hypertrophic obstructive cardiomyopathy. Circulation. 2004;109:824–7.CrossRefPubMedGoogle Scholar
  8. 8.
    ten Cate FJ, Soliman OII, Michels M, Theuns DA, de Jong PL, Geleijnse ML, et al. Long-term outcome of alcohol septal ablation in patients with obstructive hypertrophic cardio myopathy. A word of caution. Circ Heart Fail. 2010;3:362–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Veselka J, Prochazkova S, Duchonova R, Bolomova-Homolova I, Palenickova J, Tesar D, et al. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Lower alcohol dose reduces size of infarction and has comparable hemodynamic and clinical outcome. Catheter Cardiovasc Interv. 2004;63:231–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Heldman AW, Wu KC, Abraham TP, Cameron DE. Myectomy or alcohol septal ablation. Surgery and percutaneous intervention go another round. J Am Coll Cardiol. 2007;49:358–60.CrossRefPubMedGoogle Scholar
  11. 11.
    Krishnaswamy A, Tuzcu EM, Kapadia SR. Use of intra-procedural CT imaging to guide alcohol septal ablation of hypertrophic cardiomyopathy in the cardiac catheterization laboratory. Catheter Cardiovasc Interv. 2012;80:991–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Cooper RM, Binukrishnan SR, Shahzad A, Hasleton J, Sigwart U, Stables RH. Computed tomography angiography planning identifies the target vessel for optimum infarct location and improves clinical outcome in alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Eurointervention. 2017;12:e2194–203.CrossRefPubMedGoogle Scholar
  13. 13.
    Holmes DR Jr, Valeti US, Nishimura RA. Alcohol septal ablation for hypertrophic cardiomyopathy: indications and technique. Catheter Cardiovasc Interv. 2005;66:375–89.CrossRefPubMedGoogle Scholar
  14. 14.
    Faber L, Seggewiss H, Gleichmann U. Percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: results with respect to intraprocedural myocardial contrast echocardiography. Circulation. 1998;98:2415–21.CrossRefPubMedGoogle Scholar
  15. 15.
    van Dockum WG, ten Cate FJ, ten Berg JM, Beek AM, Twisk JW, Vos J, et al. Myocardial infarction after percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: evaluation by contrast-enhanced magnetic resonance imaging. J Am Coll Cardiol. 2004;43:27–34.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2019

Authors and Affiliations

  1. 1.Department of CardiologyRakuwakai Otowa HospitalKyotoJapan
  2. 2.Department of CardiologySendai Kousei HospitalSendaiJapan
  3. 3.Department of RadiologySendai Kousei HospitalSendaiJapan
  4. 4.Department of Biostatistics and EpidemiologyYokohama City UniversityYokohamaJapan

Personalised recommendations