CardioExchange Archive

Although alcohol septal ablation (ASA) for the treatment of obstructive hypertrophic cardiomyopathy is now gaining increasing acceptance in many parts of the world, a new study finds that it may cause more problems than traditional surgical myectomy. Investigators from the Netherlands, led by Patrick Serruys, studied 91 consecutive ASA patients and compared them to 40 consecutive patients who underwent myectomy during the same period. The 1-, 5-, and 8-year survival free from the composite endpoint of cardiac death and aborted sudden cardiac death was 96%, 86%, and 67%, respectively, in ASA patients compared to 100%, 96%, and 96%, respectively, in the surgical patients, according to the article in Circulation: Heart Failure. In a multivariate model, ASA was an independent predictor of the primary endpoint. In their conclusion, the authors write that “since a randomized study between ASA and myectomy is unlikely to be performed we can only rely on registries in single centers. Our data show that ASA is effective but has potentially adverse long-term effects.” Despite the growing adoption of ASA in clinical practice, the authors “recommend myectomy as the preferred treatment of choice in patients with symptomatic obstructive HCM.”