Comparative Evaluation of Alcohol Septal Ablation: Left Anterior Descending Versus Non-left Anterior Descending Artery Approaches

Alcohol septal ablation (ASA) is performed for symptomatic drug -refractory hypertrophic obstructive cardiomyopathy to reduce the left ventricular outflow tract pressure gradient (LVOTPG) by injecting ethanol into a septal branch that perforates the septal bulge. The target septal branches usually arise directly from the left anterior descending (LAD) artery; however, vessels from a non -LAD artery can be selected in some cases. This study aimed to compare the effectiveness and safety between ASA performed using a septal branch arising from a non -LAD artery and a branch arising from the LAD artery. This single -center, retrospective, observational cohort study comprised patients with hypertrophic obstructive cardiomyopathy who underwent ASA at the Gifu Heart Centre between 2011 and 2022. The effectiveness and safety of ASA using the 2 artery types were compared. The primary end points were LVOTPG and procedure success, determined as LVOTPG <30 mm Hg after 1 year. Of 33 patients (mean age 66.4 +/- 13.0 years, 13 men), 18 patients who underwent ASA using only LAD branches and 15 patients who underwent ASA using only non -LAD branches demonstrated no significant difference in the decrease in LVOTPG during the follow-up period (-99.1 +/- 47.4 mm Hg/year vs -75.7 +/- 39.2 mm Hg/year, respectively, p = 0.19). The procedure success at 1 year was not significantly different between the 2 groups (93.3% and 84.6%, respectively, p = 0.58). ASA performed using septal branches from non -LAD arteries could be an alternative treatment approach when appropriate septal branches are missing or desirable effects cannot be obtained from ASA using LAD branches. (c) 2024 Elsevier Inc. All rights reserved.