Acute and long-term results after transcoronary ablation of septal hypertrophy (TASH) - Catheter interventional treatment for hypertrophic obstructive cardiomyopathy

Aims To evaluate acute and long-term symptomatic, haemodynamic (at rest and during exercise) and electrophysiological results of transcoronary ablatio n of septal hypertrophy (TASH), a catheter interventional treatment for hyp ertrophic obstructive cardiomyopathy. Methods and Results Sixty-two transcoronary ablations of septal hypertrophy were performed by injection of 4.6 +/- 2.6 mi 96% ethanol into septal bran ches in 50 patients with hypertrophic obstructive cardiomyopathy and severe symptoms. Serial left and right heart catheterization, transoesophageal ec hocardiography and electrophysiological investigations were repeated 2 week s and 7+/-1 months (n=37) after intervention. Transcoronary ablation of sep tal hypertrophy led to a reduction in septal thickness, sustained eliminati on of the outflow obstruction (51+/-41 vs 6+/-10 mmHg at rest, P<0.001; 134 +/-48 vs 28+/-32 mmHg, P<0.001, post-extrasystolic), a decrease in left ven tricular filling pressures at rest and during exercise and a pronounced cli nical improvement. There was no evidence for the creation of an arrhythmoge nic substrate as assessed by serial programmed electrical stimulation in 39 patients. However, permanent high-grade atrioventricular block occurred in 17% of the patients. There were two early, but no late deaths during a mea n follow-up time of 10.6+/-5.6 months. Conclusion Transcoronary ablation of septal hypertrophy is a promising new treatment for hypertrophic obstructive cardiomyopathy in patients with seve re symptoms. It should now be compared with alternative treatment strategie s in prospective randomized studies.