Author + information
- Received February 1, 2017
- Accepted February 7, 2017
- Published online July 17, 2017.
- aDepartment of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands
- bDepartment of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
- ↵∗Address for correspondence:
Dr. Max Liebregts, Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands.
Twenty years after the introduction of alcohol septal ablation (ASA) for the treatment of obstructive hypertrophic cardiomyopathy, the arrhythmogenicity of the ablation scar appears to be overemphasized. When systematically reviewing all studies comparing ASA with myectomy with long-term follow-up, (aborted) sudden cardiac death and mortality rates were found to be similarly low. The focus should instead shift toward lowering the rate of reinterventions and pacemaker implantations following ASA because, in this area, ASA still seems inferior to myectomy. Part of the reason for this difference is that ASA is limited by the route of the septal perforators, whereas myectomy is not. Improvement may be achieved by: 1) confining ASA to hypertrophic cardiomyopathy centers of excellence with high operator volumes; 2) improving patient selection using multidisciplinary heart teams; 3) use of (3-dimensional) myocardial contrast echocardiography for selecting the correct septal (sub)branch; and 4) use of appropriate amounts of alcohol for ASA.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 1, 2017.
- Accepted February 7, 2017.
- 2017 American College of Cardiology Foundation