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

Israel Guerrero, Abhijeet Dhoble, Mark Fasulo, Ali E. Denktas, Shehzad Sami, Sangbum Choi, Prakash Balan, Salman A. Arain, Richard W. Smalling

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)971-977
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume88
Issue number6
DOIs
Publication statusPublished - 2016 Nov 15
Externally publishedYes

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Hypertrophic Cardiomyopathy
Safety
Arteries
Echocardiography
Cardiac Arrhythmias
Coronary Vessels

Keywords

  • alcohol septal ablation
  • coil embolization
  • hypertrophic obstructive cardiomyopathy
  • myectomy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Safety and efficacy of coil embolization of the septal perforator for septal ablation in patients with hypertrophic obstructive cardiomyopathy. / Guerrero, Israel; Dhoble, Abhijeet; Fasulo, Mark; Denktas, Ali E.; Sami, Shehzad; Choi, Sangbum; Balan, Prakash; Arain, Salman A.; Smalling, Richard W.

In: Catheterization and Cardiovascular Interventions, Vol. 88, No. 6, 15.11.2016, p. 971-977.

Research output: Contribution to journalArticle

Guerrero, Israel ; Dhoble, Abhijeet ; Fasulo, Mark ; Denktas, Ali E. ; Sami, Shehzad ; Choi, Sangbum ; Balan, Prakash ; Arain, Salman A. ; Smalling, Richard W. / Safety and efficacy of coil embolization of the septal perforator for septal ablation in patients with hypertrophic obstructive cardiomyopathy. In: Catheterization and Cardiovascular Interventions. 2016 ; Vol. 88, No. 6. pp. 971-977.
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abstract = "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.",
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T1 - Safety and efficacy of coil embolization of the septal perforator for septal ablation in patients with hypertrophic obstructive cardiomyopathy

AU - Guerrero, Israel

AU - Dhoble, Abhijeet

AU - Fasulo, Mark

AU - Denktas, Ali E.

AU - Sami, Shehzad

AU - Choi, Sangbum

AU - Balan, Prakash

AU - Arain, Salman A.

AU - Smalling, Richard W.

PY - 2016/11/15

Y1 - 2016/11/15

N2 - 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.

AB - 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.

KW - alcohol septal ablation

KW - coil embolization

KW - hypertrophic obstructive cardiomyopathy

KW - myectomy

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