Single Center Experience of Percutaneous Septal Ablation in Patients With Hypertrophic Cardiomyopathy With A Novel Agent: Polidocanol

Abstract

Septal reduction therapy is recommended in patients with obstructive hypertrophic cardiomyopathy (HCM) who remain symptomatic under maximally tolerated optimal medical treatment. Alcohol septal ablation is a favorable option, especially in patients with high surgical risk or who refuse surgery. Alcohol; causes scar-related ventricular arrhythmias and advanced heart blocks more frequently than surgical myectomy. Therefore, novel, safer agents are required for percutaneous septal ablation therapy. All the patients who underwent percutaneous septal ablation between January 2017 and June 2021 with polidocanol because of ongoing symptoms related to HCM despite maximally tolerated medical treatment were enrolled. Data were obtained retrospectively from the hospital electronic database. A total of 28 patients were included. Median age was 61 years (43.5-67), and 19 (67.8%) patients were male. Most of the patients underwent index procedures; however, only 2 cases had history of previous septal ablation. Median follow-up was 3.5 months (0.25 to 12.25). Median left ventricular outflow tract (LVOT) gradient at rest was 68.5 (37-80) mmHg, and after Valsalva maneuver median LVOT gradient was 95.5 (75-125) mmHg. Median volume of polidocanol used in procedures was 2 (2-3.37) ml, and mean procedure time was 28.1±2.5minutes. LVOT gradient invasively measured was significantly reduced (mean 76.5mm Hg vs mean 30mm Hg; p<0.001) immediately after the septal ablation. Conduction defects developed in 18 patients (64.2%); however, de novo permanent cardiac implantable electronic device implantation was required in only 4 (14.3%) cases. Leakage of polidocanol and mortality did not occur in any cases. Pericardial effusion developed in only 1 case, and it resolved with medical treatment. After mean 3.5months follow-up, both LVOT gradient and New York Heart Association functional class parameters were better than baseline values. In conclusion, polidocanol is a safe and effective agent for septal ablation in patients with HCM. Outcomes and complication rates are similar with alcohol septal ablation.