Am J Cardiol. 2026 Mar 5:S0002-9149(26)00130-X. doi: 10.1016/j.amjcard.2026.03.002. Online ahead of print.
ABSTRACT
Recent advances in pre-procedural imaging have improved risk assessment and procedural planning for alcohol septal ablation (ASA) in patients with symptomatic obstructive hypertrophic cardiomyopathy (HOCM). However, limited data exist regarding the current practice and outcomes of ASA in Japan. Data from 634 patients who underwent ASA at 72 hospitals between January 2019 and December 2022 were extracted from the nationwide prospective J-SHD registry. Baseline characteristics, procedural details, and in-hospital outcomes were evaluated, and multivariate logistic regression analyses were performed to identify predictors of procedural success and complications. The cohort consisted predominantly of females (76.5%). The mean procedure time was 168 ± 52 minutes, and the mean alcohol volume injected was 3.0 ± 1.8 mL. Successful alcohol injection was achieved in 99.6% of cases, resulting in a significant reduction of the left ventricular outflow tract (LVOT) gradient from 72.0 ± 44.0 to 20.9 ± 24.6 mmHg (P<0.001). In-hospital mortality was 0.16%, while ventricular arrhythmia and high-grade heart block requiring permanent pacemaker implantation occurred in 0.63% and 7.9% of patients, respectively. A higher pre-procedural LVOT gradient predicted successful gradient reduction, whereas female sex independently predicted high-grade heart block. In conclusion, this nationwide registry demonstrated that ASA is a safe and effective therapy for HOCM in Japan. Female sex may represent a potential risk factor for conduction disturbances requiring pacemaker implantation.
PMID:41794363 | DOI:10.1016/j.amjcard.2026.03.002