Author + information
- Christopher Capps1,
- Jeremy Rier2,
- Ashley Waring1,
- Justin Heizer3,
- Barbara Griffin4,
- Shawn Shaji1,
- Akayla Ford1,
- Billy Mullinax5,
- Sheldon Litwin1,
- Christopher Nielsen1 and
- Valerian Fernandes1
- 1Medical University of South Carolina, Charleston, South Carolina, United States
- 2Penn State Hershey Medical Center, Hershey, Pennsylvania, United States
- 3Virginia Commonwealth University, Richmond, Virginia, United States
- 4Medical University of South Carolina, College of Medicine, Charleston, South Carolina, United States
- 5MUSC, Charleston, South Carolina, United States
Alcohol septal ablation (ASA) is a safe and effective alternative to septal myectomy. However there are still concerns about the long-term prognosis of alcohol-induced septal scar.
A total of 593 consecutive patients who underwent 673 ASA procedures at MUSC from 1999 to 2015 were enrolled in the study. Evaluation included procedural deaths, pacemaker requirement, repeat ASA and long term mortality.
The cohort included 274 males and 319 females with 85% Caucasians. The mean age was 57.1±15.3 years (range 13.5y to 89y). During ASA, absolute alcohol (2.3± 0.25 cc) was injected into 1.2± 0.3 septal arteries inducing a septal infarct with a mean creatine kinase of 1239 U/L. Procedural mortality was <1% (6 of 673), with no procedural deaths occured after the year 2008. Permanent pacemaker (PPM) was needed in 54 patients (9.1%). Seventy-five patients (12.6%) required repeat ablations. The mean follow-up was 7.8± 4.3 years. (range: 3 months to 16.2 years). Over the 16 year period, 91 patients had died (15.3%). The survival estimates at 1, 5, 10 and 15 years were 97%, 92%, 89% and 81% respectively, which was similar to national age, gender and race-matched controls and also similar to septal myectomy.
In contemporary practice at a high-volume center, ASA has a high success rate, low procedural mortality and low PPM implantation rate. The temporal decline in procedural mortality and pacemaker requirement reflects a learning curve and institutional expertise. The long term survival at 16 yrs is similar to national survival curves for the normal population, suggesting that there is no detrimental effect of the alcohol induced septal scar.
STRUCTURAL: Alcohol Septal Ablation/HOCM