Comparative efficacy of particulate embolic agents versus alcohol in percutaneous transluminal septal myocardial ablation

Abstract

Background

Percutaneous transluminal septal myocardial ablation (PTSMA) is a widely used therapy for drug-refractory obstructive hypertrophic cardiomyopathy (oHCM), but alcohol ablation's non-target retrograde flow (due to high fluidity/permeability) raises complication risks, driving research into particulate embolic alternatives

Methods

This study retrospectively analyzed 132 patients with oHCM admitted to the first affiliated Hospital of Chongqing Medical University between January 2018 and July 2024. Of these, 45 patients who underwent PTSMA at our hospital were further divided into the particulate group (n = 13) and the alcohol group (n = 32) based on the type of interventional material. The analysis focused on comparing short-term clinical outcomes and post-discharge transthoracic echocardiography (TTE) results among oHCM patients undergoing PTSMA with different ablation agents

Results

The particulate group demonstrated a significantly lower incidence of intraoperative complications compared with the alcohol group (p < 0.05).The particulate group also demonstrated lower postoperative absolute cardiac troponin I(cTnI) levels (p < 0.001). The post-discharge TTE revealed a significantly higher proportion of patients with left ventricular outflow tract gradient (LVOTG) <50 mmHg in the alcohol group compared to the control group(p < 0.05)

Conclusion

Particulate embolic agents can reduce the incidence of periprocedural complications in PTSMA and may hold potential clinical utility in high-risk patients. However, the higher reintervention risk of particulate embolic agents indicates that alcohol remains the preferred embolic agent for PTSMA. Future large-scale prospective studies are needed to validate the long-term safety and efficacy of particulate embolic agents