Heart：酒精室间隔消融临床安全好

　　丹麦一项研究表明，在梗阻性肥厚型心肌病（HCM）患者中，酒精室间隔消融（ASA）显著降低了患者的危险因素数量，并且心源性猝死发生率相应较低。论文于5月3日在线发表于《心脏》（Heart）。

　　此项观察性队列研究共纳入470例HCM患者，并均给予增强超声引导ASA治疗。患者年龄为56±14岁，随访时间为8.4±4。主要转归指标为全因死亡、心源性猝死和ASA前后危险因素。

　　结果显示，ASA后10年生存率为88%（年度全因死亡率为1.2%），背景匹配人群为84%（P=0.06）。无心源性猝死的10年生存率为95%。ASA降低了异常血压应答、晕厥、非持续性室性心动过速和最大室壁厚度≥30 mm的发生率。19%的患者具有心源性猝死家族史。ASA之后，危险因素≥2的高危患者比率由25%降至8%（P<0.001）。ASA之前危险因素评分≥2与心源性猝死无关。

与消融相关的拓展阅读：

• Europace：成功的导管消融可减少CHA2DS2-VASc评分≥1分房颤患者的心血管事件发生
• Europace：存在非手术相关低电压区的右心房房速射频消融治疗效果良好
• JCE：既往存在胺碘酮相关甲亢的房颤患者导管消融后复发率较高
• Circulation：复杂性室性心律失常导管消融可改善患者长期预后
• CAE：房颤患者消融围手术期服用达比加群的安全性 更多信息请点击：有关消融更多资讯

Alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy: low incidence of sudden cardiac death and reduced risk profile
Background
The infarction induced by alcohol septal ablation (ASA) may predispose to arrhythmia and sudden cardiac death (SCD).
Objective
To assess survival, incidence of SCD after ASA and effects of ASA on the traditional risk factors (RFs) for SCD.
Design
An observational cohort-study (follow-up 8.4±4 years).
Setting
A dual-centre cohort.
Patients
470 consecutive patients (age 56±14 years) with obstructive hypertrophic cardiomyopathy (HCM) (1996–2010).
Interventions
Clinically applied echo-contrast-guided ASA treatments.
Main outcome measures
All-cause mortality, SCD and RFs for SCD before and after ASA.
Results
The 10-year survival was 88% (annual all-cause death rate 1.2%) after ASA compared with 84% (p=0.06) in a matched background population. The 10-year survival free of SCD was 95% (annual SCD rate 0.5%). ASA reduced the prevalence of abnormal blood pressure response (from 23% to 9%, p<0.001), syncope (26% to 2%, p<0.001), non-sustained ventricular tachycardia (NSVT) (23% to 17%, p<0.05) and maximal wall thickness ≥30 mm (7% to 2%, p<0.001). There was a family history of SCD in 19% of the patients. The proportion of patients at high risk—that is, two or more RFs (n=89), was reduced from 25% to 8% (p<0.001). A RF score ≥2 before ASA was not associated with SCD (n=361, p=0.31).
Conclusions
Survival in ASA-treated patients was similar to that in the background population. The number of RFs, including the prevalence of NSVT, was markedly reduced by ASA and the incidence of SCD was correspondingly low. Thus, clinically applied ASA was safe.