摘要

Twenty years after the introduction of alcohol septal ablation (ASA) for the treatment of obstructive hypertrophic cardiomyopathy, the arrhythmogenicity of the ablation scar appears to be overemphasized. When systematically reviewing all studies comparing ASA with myectomy with long-term follow-up, (aborted) sudden cardiac death and mortality rates were found to be similarly low. The focus should instead shift toward lowering the rate of reinterventions and pacemaker implantations following ASA because, in this area, ASA still seems inferior to myectomy. Part of the reason for this difference is that ASA is limited by the route of the septal perforators, whereas myectomy is not. Improvement may be achieved by: 1) confining ASA to hypertrophic cardiomyopathy centers of excellence with high operator volumes; 2) improving patient selection using multidisciplinary heart teams; 3) use of (3-dimensional) myocardial contrast echocardiography for selecting the correct septal (sub)branch; and 4) use of appropriate amounts of alcohol for ASA.

译文

在引入酒精间隔消融 (ASA) 治疗梗阻性肥厚型心肌病 20 年后，消融疤痕的心律失常性似乎被过分强调。当系统回顾所有研究比较 ASA 和长期随访的心肌切除术时，(流产的) 心脏性猝死和死亡率也同样低。相反，焦点应该转向降低 ASA 后的再干预和起搏器植入率，因为在这一领域，ASA 似乎仍然不如心肌切除术。造成这种差异的部分原因是 ASA 受间隔穿支途径的限制，而肌切除术则不受限制。改善可以通过以下方式实现: 1) 将 ASA 限制在高操作者容量的肥厚型心肌病卓越中心; 2) 使用多学科心脏团队改善患者选择; 3) 使用 (三维) 心肌声学造影选择正确的间隔 (子) 分支; 以及 4) 使用适量的酒精用于 ASA。