Septal alcohol ablation

T ble 1 Patient selection criteria for septal alcohol ablation... 

Firoozi S, Elliott PM, Sharma S, et al. Septal myotomy-myectomy and transcoronary septal alcohol ablation in hypertrophic obstructive cardiomyopathy. A comparison of clinical, haemodynamic and exercise outcomes. Eur Heart J 2002 23 1617-1624. 

Kim JJ, Lee CW, Park SW, et al. Improvement in exercise capacity and exercise blood pressure response after transcoronary alcohol ablation therapy of septal hypertrophy in hypertrophic cardiomyopathy, Am J Cardiol 1999 83(8) 1220-1223. 

Following septal ablation, patients should be monitored in a coronary care unit for 24 to 48 hours and the temporary pacing wire should be removed at the end of this period in the absence of atrioventricular block. Patients may then be transferred to a telemetry unit for monitoring of arrhythmias. Total hospitalization is usually for three to five days to monitor for occurrence of complete heart block that would require a permanent pacemaker. A sizeable infarction is induced with alcohol ablation and causes creatinine phosphokinase to peak at 1000 to 1500 one day after the ablation. Patients should be maintained on aspirin indefinitely. 

Ablation of the myocardium using alcohol is another alternative to surgery. Septal ablation with alcohol results in the same type of outcomes as seen with myectomy. Long-term follow-up is limited because this procedure has been used for less than a decade. Since it is a percutaneous procedure (similar to cardiac catheterizations), it is being done more frequently than myectomy. There is some concern that the risk for arrhythmia-related cardiac events may increase following alcohol ablation. Long-term follow-up is needed to assess this risk. Complete heart block is a common complication of septal... 

For patients with a significant obstruction to LV outflow who do not respond to medical management, a surgical approach may be necessary. Septal myectomy and alcohol ablation have been employed. These approaches generally are reserved for patients who have an outflow gradient of more than 50 mm Hg and/or severe symptoms and who have failed an adequate trial of medical therapy. 

The three-month (II) and one-year (10) results of both surgical myomectomy and alcohol septal ablation were comparable, however, surgical myomectomy was superior to ablation in terms of improved exercise test parameters (Table I) (14). Studies indicate maintenance of clinical and hemodynamic... 

Jassal DS, Neilan TG, Fifer MA, et al. Sustained improvement in left ventricular diastolic function after alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Eur Heart J 2006. 

Fernandes VL, Nagueh SF Wang W, et al. A prospective follow-up of alcohol septal ablation for symptomatic hypertrophic obstructive cardiomyopathy—the Baylor experience (1996-2002). Clin Cardiol 2005 28 124-130. 

Yoerger DM, Picard MH, Palacios IF et al. Time course of pressure gradient response after first alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Am J Cardiol 2006 97 151 I — 1514. 

Chang SM, Lakkis NM, Franklin J, et al, Predictors of outcome after alcohol septal ablation therapy in patients with hypertrophic obstructive cardiomyopathy, Circulation 2004 109 824-827. 

Talreja DR, Nishimura RA, Edwards WD, et al. Alcohol septal ablation versus surgical septal myectomy comparison of effects on atrioventricular conduction tissue, J Am Coll Cardiol 2004 44 2329-2332. 

I Veselka J, Prochazkova S, Duchonova R et al. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy Lower alcohol dose reduces size of infarction and has comparable hemodynamic and clinical outcome. Catheter Cardiovasc Interv 2004 63 231-235. 

B9. Bradham, W. S., Release of matrix metaUoproteinases following alcohol septal ablation in hypertrophic obstructive cardiomyopathy. J. Am. Coll. Cardiol. 40, 2165-2173 (2002). 

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