BACKGROUND

The infarction induced by alcohol septal ablation (ASA) may predispose to arrhythmia and sudden cardiac death (SCD).

OBJECTIVE

To assess survival, incidence of SCD after ASA and effects of ASA on the traditional risk factors (RFs) for SCD.

DESIGN

An observational cohort-study (follow-up 8.4±4 years).

SETTING

A dual-centre cohort.

PATIENTS

470 consecutive patients (age 56±14 years) with obstructive hypertrophic cardiomyopathy (HCM) (1996-2010).

INTERVENTIONS

Clinically applied echo-contrast-guided ASA treatments.

MAIN OUTCOME MEASURES

All-cause mortality, SCD and RFs for SCD before and after ASA.

RESULTS

The 10-year survival was 88% (annual all-cause death rate 1.2%) after ASA compared with 84% (p=0.06) in a matched background population. The 10-year survival free of SCD was 95% (annual SCD rate 0.5%). ASA reduced the prevalence of abnormal blood pressure response (from 23% to 9%, p<0.001), syncope (26% to 2%, p<0.001), non-sustained ventricular tachycardia (NSVT) (23% to 17%, p<0.05) and maximal wall thickness ≥30 mm (7% to 2%, p<0.001). There was a family history of SCD in 19% of the patients. The proportion of patients at high risk-that is, two or more RFs (n=89), was reduced from 25% to 8% (p<0.001). A RF score ≥2 before ASA was not associated with SCD (n=361, p=0.31).

CONCLUSIONS

Survival in ASA-treated patients was similar to that in the background population. The number of RFs, including the prevalence of NSVT, was markedly reduced by ASA and the incidence of SCD was correspondingly low. Thus, clinically applied ASA was safe.