[One-year follow-up after echocardiographically-guided percutaneous septal ablation in hypertrophic obstructive cardiomyopathy].

Background: Percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion was introduced as a new treatment option in symptomatic patients with hypertrophic obstructive cardiomyopathy. Echocardiographic monitoring of the procedure resulted in improvement of acute results. In this study we analyzed the follow-up after echocardiographic guided septal ablation.

Methods: 100 consecutive symptomatic patients (50 men; age 52.7 +/- 15.7 years; NYHA class 2.8 +/- 0.6) underwent percutaneous septal ablation with echocardiographic monitoring. All patients had clinical and non-invasive 3-months and 1 year follow-up.

Results: Acute reduction of the left ventricular outflow tract gradient was achieved in 99 patients from 76 +/- 37 to 19 +/- 21 mm Hg at rest, from 104 +/- 34 to 43 +/- 31 mm Hg during Valsalva maneuver, and from 146 +/- 45 to 59 +/- 42 mm Hg post extrasystole (p < 0.0001, each). Mean CK rise was 570 +/- 236 U/l. One patient died at day 2 due to fulminant pulmonary embolism following deep venous thrombosis, and 8 patients required a permanent DDD-pacemaker due to postinterventional complete heart block. During follow-up no further patient died. All living 99 patients showed clinical improvement to NYHA-class 1.4 +/- 0.6 after 3 months and 1.5 +/- 0.6 after 1 year (p < 0.0001, each). Non-invasive follow-up studies observed ongoing outflow tract gradient reduction, decrease of septal and left ventricular posterior wall thickness, and improvement of exercise capacity and time.

Summary: Percutaneous septal ablation is an effective treatment of symptomatic patients with hypertrophic obstructive cardiomyopathy. During one-year follow-up remodeling after induced therapeutic septal infarction resulted in improvement of acute gradient reduction with ongoing symptomatic and objective improvement and without significant complications and side-effects.