DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Background: Data on invasive septum reduction therapies in hypertrophic obstructive cardiomyopathy (HOCM) is scarce for young patients. Thus, most authors still consider surgical myectomy as the gold standard in younger patients suffering from HOCM. The purpose of this study was to evaluate the safety and effectiveness of alcohol septal ablation (ASA) for relief of symptoms and left ventricular outflow tract gradient (LVOTG) reduction in HOCM patients ≤ 25 years.
Methods and Results: All ASA procedures between 2002 and 2020 at our institution were retrospectively assigned to a group of patients ≤ 25 years (group 1) and a reference group > 25 years (group 2) and analysed at baseline and chronic follow-up (FU) after 6 months. In group 2 1,264 procedures were analysed (58.6 ± 13.5 years) and in group 1 41 procedures (20.9 ± 3.3 years). We found a higher proportion of family history of sudden cardiac death in group 1 (56.1 % vs. 24.6 % in group 2; p<.0001). A cardiac device had been more often implanted in group 1 (31.7 % vs. 9.0 % in group 2; p<.0001) and the interventricular septal diameter (IVSD) at baseline was higher in young patients (26.0 ± 6.5 mm vs. 21.3 ± 4.4 mm in group 2; p<.0001). There was no significant difference in baseline LVOTG (54.4 ± 24.4 mmHg in group 1 vs. 52.4 ± 36.6 mmHg in group 2 (p=n.s.). Symptoms were significantly improved at FU by ASA in both groups compared to baseline (group 1: mean NYHA class 2.5 at baseline and 1.3 at FU; p<.0001; group 2: mean NYHA class 2.7 at baseline and 1.4 at FU; p<.0001). Compared to baseline IVSD at FU was significantly reduced (20.3 ± 8.2 mm in the young patients at FU; 16.8 ± 5.7 mm in the reference group at FU; p<.0001 for each group compared to baseline). During FU LVOTG improved significantly (25.5 ± 20.4 mmHg in the young patients; 22.1 ± 21.7 mmHg in the reference group; p<.0001 for each group). Mortality was 0.0 % in patients ≤ 25 years and 0.9 % in the reference group.
Conclusion: ASA was safe and effective to relieve LVOT obstruction and symptoms in young adults and adolescents (14-25 years) suffering from symptomatic HOCM. The indication for ASA may be extended to this patient population. However, these results may only apply to experienced centres and thus such invasive procedures in young people should be reserved to centres with the necessary expertise.
Table: Baseline characteristics.
| ≤ 25 years (n=41) | > 25years (n=1,264) | p-value | |
| Mean age (years) | 20.9 ± 3.3 | 58.6 ± 13.5 | N/A |
| Female (%) | 39.0 | 47.3 | N/A |
| Family history of SCD (%) | 56.1 | 24.6 | <.0001 |
| History of syncope (%) | 31.7 | 22.5 | n.s. |
| Coronary artery disease (%) | 0.0 | 14.3 | .0043 |
| Therapeutic attempt with betablockers (%) | 58.5 | 49.9 | n.s |
| Therapeutic attempt with Verapamil (%) | 31.1 | 31.5 | n.s |
| Therapeutic attempt with SM previously (%) | 7.3 | 0.7 | .0054 |
| Therapeutic attempt with ASA previously (%) | 9.8 | 8.7 | n.s. |
| Pre-existing cardiac device (PM/ICD; %) | 31.7 | 9.0 | <.0001 |
| IVSD at Baseline (mm) | 26.0 ± 6.5 | 21.3 ± 4.4 | <.0001 |
| Resting LVOTG at Baseline (mmHg) | 54.4 ± 24.4 | 52.4 ± 36.6 | n.s. |
| Provoked LVOTG at Baseline (mmHg) | 121.9 ± 42.0 | 123.7 ± 53.3 | n.s. |
Figure 1 IVSD at baseline and FU in patients ≤ 25 years. ****=p<.0001.
Figure 2 LVOTG at rest at baseline and FU in patients ≤ 25 years. ****=p<.0001.
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