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Review
. 2023 Jun;10(3):1570-1579.
doi: 10.1002/ehf2.14272. Epub 2023 Jan 13.

Alcohol septal ablation in hypertrophic cardiomyopathy: For which patients?

Alexandru Achim  1   2 , Adela Mihaela Serban  1 , Stefan Dan Cezar Mot  1 , Gregor Leibundgut  2 , Madalin Marc  1 , Ulrich Sigwart  3
Affiliations
Review

Alcohol septal ablation in hypertrophic cardiomyopathy: For which patients?

Alexandru Achim et al. ESC Heart Fail. 2023 Jun.

Abstract

Percutaneous and surgical therapies for septal reduction for hypertrophic cardiomyopathy have been going head-to-head for the past 20 years with similar outcomes and mortality rates, although contemporary myectomy seems to materialize its superiority. However, on closer analysis, the external validity of studies advocating myectomy does not translate to all centres. The aim of this review was to examine the most recent data on septal reduction therapy and to attempt to phenotype the appropriate patient for each of the two treatments. The key to similar low mortality rates between ventricular septal myectomy and alcohol septal ablation appears to be proper patient selection performed in high volume clinical environments. Furthermore, we analyse the role of mavacampten (the recently approved cardiac myosin inhibitor) in replacing or complementing the two septal reduction therapies.

Keywords: Alcohol septal ablation; Hypertrophic cardiomyopathy; Left ventricular outflow tract obstruction; Mitral valve; Outcomes; Septal myectomy.

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Conflict of interest statement

The authors report no financial relationships or conflicts of interest regarding the content herein.

Figures

Figure 1
Figure 1
Schematic illustration of alcohol septal ablation and surgical myectomy procedures for hypertrophic obstructive cardiomyopathy.
Figure 2
Figure 2
The course of a decision in a patient with HCM who needs septal reduction therapy; ‘experienced hands’ refers to local centre's expertise. *Definitive age thresholds should be avoided during decision‐making. HOCM, hypertrophic obstructive cardiomyopathy; ASA, alcohol septal ablation; LBBB, left bundle branch block; RBBB, right bundle branch block; AV, atrioventricular; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting
See this image and copyright information in PMC

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