Safety and efficacy of coil embolization of the septal perforator for septal ablation in patients with hypertrophic obstructive cardiomyopathy

• Published in: Catheterization and cardiovascular interventions Vol. 88; no. 6; pp. 971 - 977
• Main Authors: Guerrero, Israel, Dhoble, Abhijeet, Fasulo, Mark, Denktas, Ali E., Sami, Shehzad, Choi, Sangbum, Balan, Prakash, Arain, Salman A., Smalling, Richard W.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 15.11.2016; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Aged, 80 and over; alcohol septal ablation; Cardiomyopathy, Hypertrophic - diagnosis; Cardiomyopathy, Hypertrophic - surgery; Catheter Ablation - methods; coil embolization; Coronary Vessels - diagnostic imaging; Coronary Vessels - surgery; Echocardiography; Embolization, Therapeutic - instrumentation; Equipment Design; Female; Heart Septum - diagnostic imaging; Heart Septum - surgery; Humans; hypertrophic obstructive cardiomyopathy; Male; Middle Aged; myectomy; Time Factors; Treatment Outcome; myectomy; hypertrophic obstructive cardiomyopathy; coil embolization; alcohol septal ablation
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.26668

Objective The objective of this study was to evaluate safety, efficacy, and durability of coil embolization of the major septal perforator of the left anterior descending coronary artery in patients with hypertrophic obstructive cardiomyopathy (HOCM). Background The long‐term effect of coil embolization therapy in HOCM patients is not well defined. Methods We evaluated 24 symptomatic HOCM patients in a single center who underwent coil embolization of the septal perforator artery(ies). Results Twenty‐four patients on optimal medical therapy presented with NYHA functional class III (75%) or IV (25%) underwent the procedure. The procedure was successful in 22 patients, with significant reduction in left ventricular outflow tract (LVOT) gradient. The functional class significantly improved to class I (54.2%) or II (41.7%) (P < = 0.01). The LVOT gradient was significantly lower during follow up echocardiography (21.3 ± 19 vs. 81.3 ± 41 mm Hg; P < = 0.01). Interventricular septal thickness decreased over time (16.3 ± 3 vs. 18.5 ± 2 mm, P< = 0.01). The procedure was aborted in one of the patients after the third coil prolapsed from the septal perforator in to the left anterior descending artery. The coil was effectively snared out. Three patients required additional coil placement in the second major septal perforator. New permanent pacemaker placement was required in one patient. However, three patients underwent ICD implantation at follow up due to ventricular arrhythmias. Conclusions The results of this study suggest that the use of coil embolization for septal ablation is safe, effective, and durable in patients with symptomatic HOCM. © 2016 Wiley Periodicals, Inc.