Single Center Experience of Percutaneous Septal Ablation in Patients With Hypertrophic Cardiomyopathy With A Novel Agent: Polidocanol

https://doi.org/10.1016/j.amjcard.2022.11.022Get rights and content

Septal reduction therapy is recommended in patients with obstructive hypertrophic cardiomyopathy (HCM) who remain symptomatic under maximally tolerated optimal medical treatment. Alcohol septal ablation is a favorable option, especially in patients with high surgical risk or who refuse surgery. Alcohol; causes scar-related ventricular arrhythmias and advanced heart blocks more frequently than surgical myectomy. Therefore, novel, safer agents are required for percutaneous septal ablation therapy.

All the patients who underwent percutaneous septal ablation between January 2017 and June 2021 with polidocanol because of ongoing symptoms related to HCM despite maximally tolerated medical treatment were enrolled. Data were obtained retrospectively from the hospital electronic database.

A total of 28 patients were included. Median age was 61 years (43.5-67), and 19 (67.8%) patients were male. Most of the patients underwent index procedures; however, only 2 cases had history of previous septal ablation. Median follow-up was 3.5 months (0.25 to 12.25). Median left ventricular outflow tract (LVOT) gradient at rest was 68.5 (37–80) mm Hg, and after Valsalva maneuver median LVOT gradient was 95.5 (75–125) mm Hg. Median volume of polidocanol used in procedures was 2 (2-3.37) ml, and mean procedure time was 28.1 ± 2.5 minutes. LVOT gradient invasively measured was significantly reduced (mean 76.5 mm Hg vs mean 30 mm Hg; p <0.001) immediately after the septal ablation. Conduction defects developed in 18 patients (64.2%); however, de novo permanent cardiac implantable electronic device implantation was required in only 4 (14.3%) cases. Leakage of polidocanol and mortality did not occur in any cases. Pericardial effusion developed in only 1 case, and it resolved with medical treatment. After mean 3.5 months follow-up, both LVOT gradient and New York Heart Association functional class parameters were better than baseline values.

In conclusion, polidocanol is a safe and effective agent for septal ablation in patients with HCM. Outcomes and complication rates are similar with alcohol septal ablation.

Section snippets

Methods

In this observational study, all consecutive patients with drug-refractory symptomatic OHCM who were appropriate for percutaneous septal reduction therapy were enrolled between January 2017 and June 2021. The patients were eligible (1) if they had HCM with severe LVOT obstruction on transthoracic echocardiography defined as LVOT gradient >30 mm Hg at rest or >50 mm Hg with physiologic provocation such as Valsalva maneuver, and (2) if they had symptoms attributable to LVOT obstruction despite

Results

A total of 28 patients were included in this study. Median age of the study population was 61 (43.5-67) years, and 9 patients (32.1%) were female. Hypertension was present in 10 (35.7%) cases, diabetes mellitus was present in 5 (17.9%) cases, and atrial fibrillation was present in 8 patients (28.6%). Most patients were under treatment with β-blockers (%82.1), and 7 patients (25%) were using calcium channel blockers. Only 2 cases were under combined treatment with both β-blocker and calcium

Discussion

Our study indicates that polidocanol is a safe and effective alternative agent for septal ablation in patients with HCM. Early outcomes are encouraging, and complication rates are similar to ASA.

Surgical myectomy is still the first-line recommendation in patients with HCM who have refractory symptoms under optimal medical treatment. However, ASA is defined as an alternative option for patients who are not fit for surgery or refuse surgery. There are several studies demonstrating the efficacy of

Disclosures

The authors have no conflicts of interest to declare.

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