Abstract
Background
Because the final myocardial scar might be theoretically associated with an increased
risk of sudden cardiac death, the long-term clinical course of patients who undergo
alcohol septal ablation (ASA) is still a matter of debate. In this retrospective multicentre
study, we report outcomes after ASA, including survival, analysis of causes of deaths,
and association between time and cause of death.
Methods
We enrolled 366 consecutive patients (58 ± 12 years, 54% women) who were treated using
ASA and followed-up for 5.1 ± 4.5 years.
Results
The in-hospital and 30-day mortality were 0.5% and 0.8%, respectively; the ASA-related
morbidity was < 20%. Overall, 52 patients died during 1867 patient-years, which means
the all-cause mortality rate was 2.8% per year. The mortality rates of sudden death
and sudden death with an appropriate implantable cardioverter-defibrillator (ICD)
discharge were 0.4% and 1% per year, respectively. Patients with sudden death or appropriate
ICD discharge experienced these mortality events at younger age than patients who
died of other hypertrophic obstructive cardiomyopathy-related causes (60.8 years [range,
52-71.5 years] vs 72.4 years [range, 64.2-75.2 years]; P = 0.048). A total of 292 patients (80%) had an outflow gradient ≤ 30 mm Hg, and 327
patients (89%) were in New York Heart Association class ≤ II at the last clinical
check-up.
Conclusions
ASA had low procedure-related mortality, with subsequent 1% occurrence of sudden mortality
events per year and 2.8% mortality rate per year in the long-term follow-up. Patients
with sudden death or ICD discharge experienced the mortality events approximately
1 decade earlier than patients who died from other causes not related to hypertrophic
cardiomyopathy.
Résumé
Introduction
Puisque la cicatrisation finale du myocarde serait en théorie associée à une augmentation
du risque de mort cardiaque subite, l’évolution clinique à long terme des patients
qui subissent l’ablation septale à l’alcool (ASA) fait encore l’objet de discussions.
Dans cette étude multicentrique rétrospective, nous rapportons les résultats cliniques
après l’ASA, y compris la survie, l’analyse des causes de la mort, et l’association
entre le moment et la cause de la mort.
Méthodes
Nous avons inscrit 366 patients consécutifs (de 58 ± 12 ans, 54 % de femmes) qui ont
été traités par ASA et suivis durant 5,1 ± 4,5 ans.
Résultats
La mortalité intrahospitalière et la mortalité à 30 jours étaient respectivement de
0,5 % et de 0,8 %; la morbidité liée à l’ASA était de < 20 %. Dans l’ensemble, 52
patients sont morts durant 1867 patients-années, ce qui signifie que le taux de mortalité
toutes causes confondues était de 2,8 % par année. Les taux de mortalité liés à la
mort subite et à la mort subite avec une décharge électrique appropriée d’un défibrillateur
cardioverteur implantable (DCI) étaient respectivement de 0,4 % et de 1 % par année.
Les patients ayant subi une mort subite ou une décharge électrique appropriée du DCI
ont expérimenté ces événements de mortalité à un plus jeune âge que les patients qui
sont morts d’autres causes liées à la cardiomyopathie hypertrophique (60,8 ans [étendue,
52-71,5 ans] vs 72,4 ans [étendue, 64,2-75,2 ans]; P = 0,048). Un total de 292 patients (80 %) avaient un gradient de débit ≤ 30 mm Hg,
et 327 patients (89 %) appartenaient à une classe ≤ II de la New York Heart Association
selon le dernier bilan de santé clinique.
Conclusions
L’ASA a montré une faible mortalité liée à l’intervention, dont une survenue subséquente
de mort subite de 1 % par année et un taux annuel de mortalité de 2,8 % au cours du
suivi à long terme. Les patients ayant subi une mort subite ou une décharge électrique
du DCI ont expérimenté des événements de mortalité approximativement 1 décennie plus
tôt que les patients qui sont morts de causes non liées à la cardiomyopathie hypertrophique.
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Article info
Publication history
Published online: February 19, 2015
Accepted:
February 13,
2015
Received:
January 10,
2015
Footnotes
See page 1251 for disclosure information.
Identification
Copyright
© 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
