Data regarding alcohol septal ablation (ASA) in young patients with hypertrophic obstructive cardiomyopathy (HOCM) are scarce. The purpose of our study is to evaluate the safety and efficacy of ASA in patients ≤ 25 years.
Methods and results
All ASAs between 2002 and 2020 at our institution were assigned to a group of patients 14–25 years of age (group 1) and a reference group > 25 years (group 2). 1,264 procedures were analysed in group 2 (58.6 ± 13.5 years) and 41 procedures in group 1 (20.9 ± 3.3 years). The baseline interventricular septal diameter (IVSD) was higher in group 1 (26.0 ± 6.5 mm vs. 21.3 ± 4.4 mm; p < 0.0001). There was no difference in baseline left ventricular outflow tract gradient (LVOTG) (group 1: 54.4 ± 24.4 mmHg; group 2: 52.4 ± 36.6 mmHg; p = n.s.). A previous cardiac device was more often observed in group 1 (31.7% vs. 9.0%; p < 0.0001). Symptoms were improved after 6 months (group 1: mean NYHA class 2.5 at baseline and 1.3 at FU; p < 0.0001; group 2: mean NYHA class 2.7 at baseline and 1.4 at FU; p <0 .0001). IVSD (group 1: 20.3 ± 8.2 mm; group 2: 16.8 ± 5.7 mm; p < 0.0001 for each group compared to baseline) and LVOTG improved during FU (group 1: 25.5 ± 20.0 mmHg; group 2: 22.1 ± 21.7 mmHg; p < 0.0001 for each group). Intrahospital mortality was 0.0% in patients 14–25 years and 0.9% in the reference group. Persistent AV-block was observed in 12.2% of the group 1 and 15.9% of the group 2 patients (p = n.s.).
ASA is safe and effective in HOCM patients 14–25 years of age in experienced centres.
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Maron BJ, Gardin JM, Flack JM et al (1995) Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA Study. Coronary Artery Risk Development in (Young) Adults. Circulation 92:785–789. https://doi.org/10.1161/01.cir.92.4.785
Maron MS, Olivotto I, Betocchi S et al (2003) Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med 348:295–303. https://doi.org/10.1056/NEJMoa021332
Elliott PM, Anastasakis A et al (2014) 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 35:2733–2779. https://doi.org/10.1093/eurheartj/ehu284
Morrow AG, Reitz BA, Epstein SE et al (1975) Operative treatment in hypertrophic subaortic stenosis. Techniques, and the results of pre and postoperative assessments in 83 patients. Circulation 52:88–102. https://doi.org/10.1161/01.cir.52.1.88
Kuhn H, Gietzen F, Leuner C, Gerenkamp T (1997) Induction of subaortic septal ischaemia to reduce obstruction in hypertrophic obstructive cardiomyopathy. Studies to develop a new catheter-based concept of treatment. Eur Heart J 18:846–851
Sigwart U (1995) Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy. Lancet 346:211–214. https://doi.org/10.1016/s0140-6736(95)91267-3
Agarwal S, Tuzcu EM, Desai MY et al (2010) Updated meta-analysis of septal alcohol ablation versus myectomy for hypertrophic cardiomyopathy. J Am Coll Cardiol 55:823–834. https://doi.org/10.1016/j.jacc.2009.09.047
Leonardi RA, Kransdorf EP, Simel DL, Wang A (2010) Meta-analyses of septal reduction therapies for obstructive hypertrophic cardiomyopathy: comparative rates of overall mortality and sudden cardiac death after treatment. Circ Cardiovasc Interv 3:97–104. https://doi.org/10.1161/CIRCINTERVENTIONS.109.916676
Osman M, Kheiri B, Osman K et al (2019) Alcohol septal ablation vs myectomy for symptomatic hypertrophic obstructive cardiomyopathy: Systematic review and meta-analysis. Clin Cardiol 42:190–197. https://doi.org/10.1002/clc.23113
Lipshultz SE, Sleeper LA, Towbin JA et al (2003) The incidence of pediatric cardiomyopathy in two regions of the United States. N Engl J Med 348:1647–1655. https://doi.org/10.1056/NEJMoa021715
Seggewiss H, Rigopoulos A (2003) Management of hypertrophic cardiomyopathy in children. Paediatr Drugs 5:663–672. https://doi.org/10.2165/00148581-200305100-00002
Pacileo G, De Cristofaro M, Russo MG et al (2000) Hypertrophic cardiomyopathy in pediatric patients: effect of verapamil on regional and global left ventricular diastolic function. Can J Cardiol 16:146–152
Georgakopoulos D, Tolis V (2007) Hypertrophic cardiomyopathy in children, teenagers and young adults. Hellenic J Cardiol 48:228–233
Ommen SR, Mital S et al (2020) 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. https://doi.org/10.1161/CIR.0000000000000937
Zhu C, Wang S, Ma Y et al (2019) Childhood hypertrophic obstructive cardiomyopathy and its relevant surgical outcome. Ann Thorac Surg. https://doi.org/10.1016/j.athoracsur.2019.10.016
Xu H, Yan J, Wang Q et al (2016) Extended septal myectomy for hypertrophic obstructive cardiomyopathy in children and adolescents. Pediatr Cardiol 37:1091–1097. https://doi.org/10.1007/s00246-016-1396-5
Theodoro DA, Danielson GK, Feldt RH, Anderson BJ (1996) Hypertrophic obstructive cardiomyopathy in pediatric patients: results of surgical treatment. J Thorac Cardiovasc Surg 112:1589–1597. https://doi.org/10.1016/S0022-5223(96)70018-1 (discussion 1597–1599)
Minakata K, Dearani JA, O’Leary PW, Danielson GK (2005) Septal myectomy for obstructive hypertrophic cardiomyopathy in pediatric patients: early and late results. Ann Thorac Surg 80:1424–1429. https://doi.org/10.1016/j.athoracsur.2005.03.109 (discussion 1429–1430)
Delmo Walter EMB, Siniawski H, Hetzer R (2009) Sustained improvement after combined anterior mitral valve leaflet retention plasty and septal myectomy in preventing systolic anterior motion in hypertrophic obstructive cardiomyopathy in children. Eur J Cardiothorac Surg 36:546–552. https://doi.org/10.1016/j.ejcts.2009.03.049
Altarabsheh SE, Dearani JA, Burkhart HM et al (2013) Outcome of septal myectomy for obstructive hypertrophic cardiomyopathy in children and young adults. Ann Thorac Surg 95:663–669. https://doi.org/10.1016/j.athoracsur.2012.08.011 (discussion 669)
Abbey S, Guérin P, Gournay V et al (2005) Septal alcoholisation of hypertrophic obstructive cardiomyopathy in childhood. Arch Mal Coeur Vaiss 98:574–578
Cano MN, Fortunato de Cano SJ, Sousa JEMR (2010) Alcohol septal ablation after myomectomy failure solutions for unusual cases. Catheter Cardiovasc Interv 76:719–723. https://doi.org/10.1002/ccd.22539
Emmel M, Sreeram N (2005) Radiofrequency catheter septal ablation for hypertrophic obstructive cardiomyopathy in children. Neth Heart J 13:448–451
Sreeram N, Emmel M, de Giovanni JV (2011) Percutaneous radiofrequency septal reduction for hypertrophic obstructive cardiomyopathy in children. J Am Coll Cardiol 58:2501–2510. https://doi.org/10.1016/j.jacc.2011.09.020
Subash Chandra V, Jayranganth M, Shenoy AR (2006) Non-surgical septal reduction for hypertrophic cardiomyopathy in childhood. Int J Cardiol 106:355–359. https://doi.org/10.1016/j.ijcard.2005.02.009
Zhang X, Li Y, Xie B et al (2011) Non-drug treatment for hypertrophic obstructive cardiomyopathy in children. Zhonghua Er Ke Za Zhi 49:381–385
Hickey EJ, McCrindle BW, Larsen S-H et al (2012) Hypertrophic cardiomyopathy in childhood: disease natural history, impact of obstruction, and its influence on survival. Ann Thorac Surg 93:840–848. https://doi.org/10.1016/j.athoracsur.2011.10.032
Lawrenz T, Lieder F, Bartelsmeier M et al (2007) Predictors of complete heart block after transcoronary ablation of septal hypertrophy. J Am Coll Cardiol 49:2356–2363. https://doi.org/10.1016/j.jacc.2007.02.056
Nagueh SF, Groves BM, Schwartz L et al (2011) Alcohol septal ablation for the treatment of hypertrophic obstructive cardiomyopathy. A multicenter North American registry. J Am Coll Cardiol 58:2322–2328. https://doi.org/10.1016/j.jacc.2011.06.073
Gietzen FH, Leuner CJ, Raute-Kreinsen U et al (1999) Acute and long-term results after transcoronary ablation of septal hypertrophy (TASH). Catheter interventional treatment for hypertrophic obstructive cardiomyopathy. Eur Heart J 20:1342–1354. https://doi.org/10.1053/euhj.1999.1520
Liebregts M, Faber L, Jensen MK et al (2017) Outcomes of alcohol septal ablation in younger patients with obstructive hypertrophic cardiomyopathy. JACC Cardiovasc Interv 10:1134–1143. https://doi.org/10.1016/j.jcin.2017.03.030
An S, Yang Y, Hang F et al (2017) Procedural complication and long term outcomes after alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy: data from China. Sci Rep 7:9506. https://doi.org/10.1038/s41598-017-10144-0
Rangavajla G, Mulukutla S, Thoma F et al (2021) Ventricular pacing and myocardial function in patient with congenital heart block. J Cardiovasc Electrophysiol. https://doi.org/10.1111/jce.15207
Galve E, Sambola A, Saldaña G et al (2010) Late benefits of dual-chamber pacing in obstructive hypertrophic cardiomyopathy: a 10-year follow-up study. Heart 96:352–356. https://doi.org/10.1136/hrt.2008.158915
Lucon A, Palud L, Pavin D et al (2013) Very late effects of dual chamber pacing therapy for obstructive hypertrophic cardiomyopathy. Arch Cardiovasc Dis 106:373–381. https://doi.org/10.1016/j.acvd.2013.04.003
Megevand A, Ingles J, Richmond DR, Semsarian C (2005) Long-term follow-up of patients with obstructive hypertrophic cardiomyopathy treated with dual-chamber pacing. Am J Cardiol 95:991–993. https://doi.org/10.1016/j.amjcard.2004.12.045
Slade AK, Sadoul N, Shapiro L et al (1996) DDD pacing in hypertrophic cardiomyopathy: a multicentre clinical experience. Heart 75:44–49. https://doi.org/10.1136/hrt.75.1.44
Kim LK, Swaminathan RV, Looser P et al (2016) Hospital volume outcomes after septal myectomy and alcohol septal ablation for treatment of obstructive hypertrophic cardiomyopathy: US Nationwide Inpatient Database, 2003–2011. JAMA Cardiol 1:324–332. https://doi.org/10.1001/jamacardio.2016.0252
This research was not supported by any funding.
Conflict of interest
The authors declare that they have no conflicts of interest.
The research project was approved by the ethics committee of the Westfälische Wilhelms-University Münster, Germany (file number 2020-780-f-S).
Consent to participate
Referring to the national ethical guidelines of Germany (§6 Gesundheitsdatenschutzgesetz NRW), the authors waived consent to participate due to retrospective study design and only intra-departmental data collection in our analysis. This was approved by the ethics committee of the Westfälische Wilhelms-University Münster, Germany (file number 2020-780-f-S).
Consent for publication
Referring to the national ethical guidelines of Germany (§6 Gesundheitsdatenschutzgesetz NRW), the authors waived consent to publication due to retrospective study design and only intra-departmental data collection in our analysis. This was approved by the ethics committee of the Westfälische Wilhelms-University Münster, Germany (file number 2020-780-f-S).
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Lawin, D., Lawrenz, T., Radke, K. et al. Safety and efficacy of alcohol septal ablation in adolescents and young adults with hypertrophic obstructive cardiomyopathy. Clin Res Cardiol (2021). https://doi.org/10.1007/s00392-021-01960-6
- Alcohol septal ablation
- Hypertrophic obstructive cardiomyopathy
- Young adults