| Ⅰ LONG-TERM SURVIVAL OF PERCUTANEOUS TRANSLUMINAL SEPTAL ABLATION IN PATIENTS WITH OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHYOBJECTIVE: To evaluate Long-term survival of patients with Obstructive Hypertrophic Cardiomyopathy(HOCM)after Percutaneous Transluminal Septal Ablation(PTSMA).METHODS: 104(except one died after an operation in hospitalization)consecutive patients with obstructive hypertrophic cardiomyopathy who underwent PTSMA in Shanghai Chest Hospital,Shanghai Jiao Tong University from April 2001 year to February 2019 year were retrospectively included and reviewed for general information、medical history、in-hospital major adverse cardiovascular events and follow-up.For the long-term outcomes,2 control groups were designed,one is selected from a cohort of 125 non-obstructive HCM patients,matched by age,hypertension,diabetes,coronary heart disease and atrial fibrillation.Another group includes patients with obstructive hypertrophic cardiomyopathy who receiving Surgical Myectomy during the same period.RESULTS: A total of 104 patients with HOCM who underwent PTSMA were enrolled with aged(54 ± 15)years old,including 41 females(38.7%).The follow-up time was 37.5(14.3,76.8)months.At the last follow-up,12 patients died(HOCM-PTSMA death group)and 92 survivors(HOCM-PTSMA survival group).The proportion of patients with NYHA function class III/IV in the HOCM-PTSMA death group was higher than that in the HOCM-PTSMA survival group(P=0.036),and the thickness of the posterior wall of the left ventricle was greater than that in the PTSMA-HOCM survival group(P=0.006).The immediate success rate of PTSMA in selected HOCM patients was 66%(70/104).The amount of absolute alcohol during the operation in the HOCM-PTSMA death group was(2.9 ± 0.8)ml which was higher than that in the HOCM-PTSMA survival group [(2.4 ± 1.0)ml],but the difference was not statistically significant(P=0.056).Kaplan-Meier survival curve analysis showed that patients with HOCM who underwent PTSMA had an all-cause mortality rate of 90.1%,78.3%,and 56.9% at 5 years,and a survival rate of HOCM-free deaths of 91.3% and 79.4% and 57.7% respectively.Multivariate Cox regression analysis showed that age≥65 years was an independent risk factor for all-cause death after PTSMA in patients with HOCM(HR=2.697,95% CI 1.292-18.977,= 0.020).There were 32 patients in the Surgical Myectomy group.The proportion of patients with NYHA function class III/IV was higher than that in the PTSMA group(P <0.001)while age,gender,and major comorbidities(atrial fibrillation,coronary heart disease,hypertension,and diabetes)as well as the inner diameter of the left atrium were all not significantly different between the two groups(P value> 0.05).Patients in the Surgical Myectomy group were followed up for 38(17.6,64.2)months,and no deaths occurred during the follow-up period.Five deaths occurred in 83 patients with non-obstructive Hypertrophic Cardiomyopathy matched by age,hypertension,diabetes,coronary heart disease,and atrial fibrillation with a follow-up 55.0(29.2,83.0)months.Kaplan-Meier survival curve analysis showed that there was no significant difference between all-cause and HOCM-related mortality in PTSMA group and patients with ventricular septal myomectomy or non-Obstructive Hypertrophic Cardiomyopathy.CONCLUSIONS: Patients with obstructive hypertrophic cardiomyopathy have a satisfactory long-term survival after Percutaneous transluminal septal ablation compared with those patients undergoing Surgical Myectomy or patients with non-obstructive hypertrophic cardiomyopathy matched by age,hypertension,diabetes,coronary heart disease and atrial fibrillation.Ⅱ EFFICACY AND SAFETY OF PERCUTANEOUS TRANSLUMINAL SEPTAL MYOCARDIAL ABLATION IN ELDERLY PATIENTS WITH OBSTRUCIVE HYPERTROPHIC CARDIOMYOPATHYBACKGROUND AND PURPOSE: The efficacy and safety of Percutaneous Transluminal Septal Myocardial Ablation,(PTSMA)in elderly symptomatic patients with drug-refractory obstructive hypertrophic cardiomyopathy is not conformed.METHODS: 111 consecutive patients with obstructive hypertrophic cardiomyopathy who underwent PTSMA of Shanghai Chest Hospital,Shanghai Jiao Tong University were retrospectively included and reviewed for general information、medical history、in-hospital major Adverse cardiovascular events and follow-up.Patients were divided into young(age <55 years)and elderly(age ≥55 years)groups.RESULTS:111 patients were included in the study,the median age was 56(15,82),and there were 42 females(37.8%),among which the median age was 43.5(15,54)in the youth group and 63(55,82)in the elderly group.The overall success rate of PTSMA was 68.5%,the success rate of the youth group and the elderly group were 66.7% & 70% respectively.The median injection amount of anhydrous alcohol was 2ml(1,5),2.1ml(1,5)in the young group and 2ml(1,5)in the old group(p=0.724).atrioventricular block,ventricular arrhythmia,hypotension were common complications of operation,and 2 cases(55~ 64 years old)need to be implanted with permanent pacemaker due to continuous high atrioventricular block,1 patients(66 years old)died due to ventricular fibrillation,cardiac shock.The incidence of major perioperative cardiovascular events(including cardiac death,permanent pacemaker implantation due to high atrioventricular block,resuscitation of cardiac arrest due to ventricular fibrillation or ventricular velocity)in elderly patients was higher than that in young patients(p=0.06).The remaining 110 patients were followed up for a median follow-up period of 35.5 months(range 3-212months)except 1 case died during perioperative period,with a follow-up rate of 86.4%(95/110),11 cases died 10%(11/110).One patient died of pulmonary infection,and the remaining 10 patients died of hypertrophic cardiomyopathy related cause including 6 patients died of sudden cardiac death,3 patients died of atrial fibrillation,acute cerebral infarction,and 1 patient died of heart failure.The overall survival rates after PTSMA in 1,5 and 10 years of all patients were 96.9%,93.4% and 81.1%.The overall survival rates after PTSMA in 1,5 and 10 years were 97.7%、97.7%、91.6% in youth group and 96.2%、89.7%、66.4% in elderly group,p=0.068.CONCLUSIONS: The effect of alcohol ablation in elderly patients with obstructive hypertrophic cardiomyopathy was comparable to that of young patients,however,the risk of major cardiovascular events associated with surgery may increase and the long-term overall survival rate after PTSMA was slightly lower than that of young patients.Ⅲ FIVE-YEAR OUTCOMES AFTER CATHETER ABLATION FOR ATRIAL FIBRILLATION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHYBACKGROUND: Catheter ablation(CA)is a promising option in most patients with refractory atrial fibrillation(AF).However,data on over 5 years’ outcomes with larger numbers in hypertrophic cardiomyopathy(HCM)patients with AF have not been reported.We assessed the outcome of 120 HCM patients following CA compared with a non-CA group and general patients without AF matched by HCM type with a 61.9±31.6-month follow-up.METHODS AND RESULTS: A total 120 patients(age 61±9.8 years,female n=43,35.8%)with paroxysmal AF(n=60,50%)and persistent AF(n=60,50%)were enrolled.Of the 120 patients,48(40%)required redo procedures,and 82(68.3%)were in sinus rhythm at the last evaluation.The composite clinical events rate following the initial CA was lower than that in the non-CA group(p=0.023)and was also comparable to that in general patients without AF matched by HCM type(p=0.729).Female(HR 2.358,95% CI 1.151~4.831;P =0.019),NYHA functional class Ⅲ-Ⅳ(HR 2.422,95% CI 1.032~5.685;P =0.042)and Left Atrial Diameter ≥ 50mm(HR 3.319,95% CI 1.469~7.499;P =0.004)were predictors of AF recurrence after multiple procedures.CONCLUSIONS: CA was successful in restoring long-term sinus rhythm and improving symptomatic status in most HCM patients with refractory AF especially for those patients with small atrial size and mild symptoms.In addition,CA may contribute to the prevention of major clinical adverse events in the long-term clinical course. |
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