Impact of ethanol dosing on the long-term outcome of alcohol septal ablation for obstructive hypertrophic cardiomyopathy: a single-center prospective, and randomized study.

Abstract

BACKGROUND:

The impact of ethanol dose on the long-term outcome of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy was investigated.

METHODS AND RESULTS:

Fifty-four patients (age 24-82 years; 65% women) undergoing ASA were randomized into 2 groups according to the dose of injected ethanol: Group A 1-2 ml, Group B >2 ml. Clinical and echocardiographic data were obtained at baseline and during follow-up. The volume of ethanol injected was 1.50+/-0.4 and 2.60+/-0.6 ml (p<0.001) with a subsequent peak of creatine kinase-MB of 2.25+/-1.00 and 2.62+/-1.57 microkat/L (p=0.02) in Groups A and B, respectively. The median follow-up was 39 (range 6-72) months after ASA, during which 1 patient died and 1 repeat procedure was necessary in both groups of patients. Both groups had a significant and similar improvement in outflow pressure gradient, dyspnea (New York Heart Association functional class) and angina pectoris (Canadian Cardiovascular Society class) (p<0.001). There was a significant decrease in the left ventricular ejection fraction (LVEF) in Group B (81+/-7 vs 75+/-7%; p=0.002), but not in Group A (80+/-7 vs 79+/-7%; p=0.67). Thinning of the basal septum was more pronounced in Group B than in Group A (9.3+/-5.7 vs 6.6+/-3.4 mm; p=0.04).

CONCLUSIONS:

A lower dose of ethanol injected into the target septal branch reduces both the size of necrosis and subsequent thinning of the basal septum, and preserves LVEF during long-term follow-up. Moreover, the low dose (1-2 ml) is as safe and as hemodynamically efficacious as higher doses.

• Authors: Josef Veselka, Radka Duchonová, Jana Páleníckova, David Zemánek, Marie Tiserová, Katerina Linhartová, Pavel Cervinka
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 70 Issue 12 Pg. 1550-2 (Dec 2006) ISSN: 1346-9843 [Print] Japan
• PMID: 17127797 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Cardiovascular Agents
• Ethanol

Topics

• Adult
• Aged
• Cardiac Catheterization
• Cardiomyopathy, Hypertrophic (therapy)
• Cardiovascular Agents (administration & dosage)
• Ethanol (administration & dosage)
• Female
• Humans
• Injections, Intralesional
• Male
• Middle Aged
• Prospective Studies
• Treatment Outcome