Abstract 14235: Alcohol Septal Ablation Using Septal Branches From the Non-Left Anterior Descending Artery Demonstrates Similar Effectiveness Compared to Septal Branches From Left Anterior Descending Artery

Abstract

Introduction: Alcohol septal ablation (ASA) is performed on symptomatic, drug-refractory hypertrophic obstructive cardiomyopathy to reduce pressure gradient in the left ventricular outflow tract (LVOT), usually using the major septal branch from the left anterior descending (LAD) artery. In some cases, a septal branch from other than LAD may be selected as an alternative target that perfuses the basal septum. The aim of this study is to evaluate the effectiveness and safety of ASA using non-LAD branches compared to ASA using major branches directly from the LAD. Methods: We conducted a single-center, retrospective, observational cohort study comprising patients who underwent ASA between 2011 and 2023. The primary outcome was the success rate, defined as a pressure gradient in the LVOT of less than 30 mmHg one year after ASA. The secondary outcomes were all-cause death, cardiac rehospitalization, and newly-developed conduction system disorders. Results: The study enrolled 36 patients (age: 66.6± 12.7 years; 13 men), and pressure gradients in LVOT before ASA were not significantly different in the two groups (76±50 mmHg in the non-LAD group (n =17) vs. 76±39 mmHg in the LAD group (n = 19), p= 0.90). The non-LAD and LAD groups had similar success rates of 88.2 % and 86.7 %, respectively, at one year (p > 0.99). The decrease in the pressure gradient in LVOT was similarly observed in both groups (61±44 mmHg in the non-LAD group vs. 61±35 mmHg in the LAD group, p=0.87). No patient died in either group within one year following ASA. The study found a non-significant incidence of newly-developed conduction system disorder (11.8 % in the non-LAD group vs. 5.3 % in the LAD group, P= 0.92). Conclusions: ASA using the non-LAD artery demonstrated similar effectiveness in decreasing the pressure gradient in the LVOT and similar safety compared to using the septal branch from the LAD at one year. Therefore, the non-LAD artery may become an alternative option for the target vessel in ASA.