Liebregts Max, Steggerda Robbert C, Vriesendorp Pieter A, van Velzen Hannah, Schinkel Arend F L, Willems Rik, van Cleemput Johan, van den Berg Maarten P, Michels Michelle, ten Berg Jurriën M
Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands.
Department of Cardiology, Martini Hospital, Groningen, the Netherlands.
JACC Cardiovasc Interv. 2016 Mar 14;9(5):463-9. doi: 10.1016/j.jcin.2015.11.036.
The aim of this study was to compare outcomes of alcohol septal ablation (ASA) in young and elderly patients with obstructive hypertrophic cardiomyopathy (HCM).
The American College of Cardiology Foundation/American Heart Association guidelines reserve ASA for elderly patients and patients with serious comorbidities. Information on long-term age-specific outcomes after ASA is scarce.
This cohort study included 217 HCM patients (age 54 ± 12 years) who underwent ASA because of symptomatic left ventricular outflow tract obstruction. Patients were divided into young (age ≤55 years) and elderly (age >55 years) groups and matched by age in a 1:1 fashion to nonobstructive HCM patients.
Atrioventricular block following ASA was more common in elderly patients (43% vs. 21%; p = 0.001), resulting in pacemaker implantation in 13% and 5%, respectively (p = 0.06). Residual left ventricular outflow tract gradient, post-procedural New York Heart Association functional class, and necessity for additional septal reduction therapy was comparable between age groups. During a follow-up of 7.6 ± 4.6 years, 54 patients died. The 5- and 10-year survival following ASA was 95% and 90% in patients age ≤55 years and 93% and 82% in patients age >55 years, which was comparable to their control groups. The annual adverse arrhythmic event rate following ASA was 0.7%/year in young patients and 1.4%/year in elderly patients, which was comparable to their control groups.
ASA is similarly effective for reduction of symptoms in young and elderly patients; however, younger patients have a lower risk of procedure-related atrioventricular conduction disturbances. The long-term mortality rate and risk of adverse arrhythmic events following ASA are low, both in young and elderly patients, and are comparable to age-matched nonobstructive HCM patients.
本研究旨在比较年轻和老年梗阻性肥厚型心肌病（HCM）患者酒精室间隔消融术（ASA）的治疗结果。
美国心脏病学会基金会/美国心脏协会指南将ASA保留用于老年患者和有严重合并症的患者。关于ASA后长期年龄特异性结果的信息很少。
这项队列研究纳入了217例因症状性左心室流出道梗阻而接受ASA的HCM患者（年龄54±12岁）。患者分为年轻组（年龄≤55岁）和老年组（年龄>55岁），并以1:1的方式按年龄与非梗阻性HCM患者匹配。
ASA后房室传导阻滞在老年患者中更常见（43%对21%；p = 0.001），分别导致13%和5%的患者植入起搏器（p = 0.06）。年龄组之间的残余左心室流出道梯度、术后纽约心脏协会功能分级以及额外间隔减容治疗的必要性相当。在7.6±4.6年的随访期间，54例患者死亡。年龄≤55岁的患者ASA后5年和10年生存率分别为95%和90%，年龄>55岁的患者为93%和82%，与对照组相当。ASA后年轻患者每年不良心律失常事件发生率为0.7%/年，老年患者为1.4%/年，与对照组相当。
ASA在年轻和老年患者中减轻症状的效果相似；然而，年轻患者与手术相关的房室传导障碍风险较低。ASA后年轻和老年患者的长期死亡率和不良心律失常事件风险较低，且与年龄匹配的非梗阻性HCM患者相当。
