The following is the summary of “Single Center Experience of Percutaneous Septal Ablation in Patients With Hypertrophic Cardiomyopathy With A Novel Agent: Polidocanol” published in the December 2022 issue of Cardiovascular Disease by Ates, et al.

Patients with obstructive hypertrophic cardiomyopathy (HCM) who continue to experience symptoms despite appropriate medical treatment should be considered for septal reduction therapy. In patients who are either too high risk for surgery or decline it, alcohol septal ablation is a good alternative. Alcohol is more common than surgical myectomy in causing ventricular arrhythmias and progressive heart blockages connected to scar tissue. Accordingly, percutaneous septal ablation therapy needs novel, safer agents.

Patients who continued to experience HCM-related symptoms despite maximally tolerated medical treatment were eligible for enrollment if they underwent percutaneous septal ablation with polidocanol between January 2017 and June 2021. The hospital’s electronic database was mined for historical data. There were a total of 28 participants. Patients’ ages ranged from 43.5 to 67, with a median of 61, and 19 (67.8%) were male. The majority of the surgeries were index procedures, and only 2 patients had a prior history of septal ablation. After a median of 3.5 months (0.25 to 12.25). In a resting state, the median gradient in the left ventricular outflow tract (LVOT) was 68.5 (37-80 mm Hg), but in response to the Valsalva maneuver, the median LVOT gradient increased to 95.5 (75-125 mm Hg). A mean of 28.1 2.5 minutes was spent on each procedure, with a median volume of 2 (2-3.37 ml) of polidocanol utilized. Immediate post-septal ablation measurements showed a dramatic decrease in the LVOT gradient (mean 76.5 mm Hg vs. mean 30 mm Hg; P<0.001). 18 patients (64.2%) acquired conduction abnormalities, although only 4 (14.3%) required installation of a de novo permanent cardiac implanted electronic device. 

No incidences of polidocanol leakage or fatalities occurred. Only 1 patient experienced the development of pericardial effusion, and it was successfully treated. Both the LVOT gradient and the New York Heart Association functional class improved from pre-treatment levels after a mean of 3.5 months of follow-up. To sum up, polidocanol is a reliable and efficient drug for septal ablation in HCM patients. Alcohol septal ablation has the same success and complication rates as the other methods.

Source: sciencedirect.com/science/article/abs/pii/S0002914922012176