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Percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy: managing the risk of procedure-related AV conduction disturbances.

AbstractAIM:
To provide tools for predicting the course of AV conduction disturbances after ethanol-induced septal ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM).
METHODS AND RESULTS:
Based on a scoring system developed 1996-1998 and including parameters from baseline ECG, heart rate profile, severity of outflow obstruction (LVOTO), peri-interventional enzyme kinetics, and peri-interventional conduction problems, the risk of permanent AV block following PTSMA was assessed in 155 consecutive HOCM patients (pts.; mean age: 53+/-13 years) between 1999 and 2004. During PTSMA with 2.1+/-0.5 ml of ethanol, transient complete AV block occurred in 71 pts. (46%). Pts. were grouped into a low, intermediate, and high risk group for permanent conduction damage, and treated accordingly (early discharge from monitoring, prolonged monitoring, early DDD-PM implantation). Permanent pacing was necessary in 11 cases (7%), 0/116 of these (0%) in the low, 4/31 (13%) in the intermediate, and 7/8 (87%) in the high-risk group. While a new right bundle branch block was the most frequent ECG finding after PTSMA, a left bundle branch block at baseline was associated with 4 of the 11 DDD-PM implantations (p<0.0001). In-hospital mortality was 0%, short-term (3-months) follow up was complete. During follow-up, AV conduction recovered in 4 pts. (46%) with a DDD-PM. New onset AV blocks did not occur. Significant improvement of symptoms was reported by 141 pts. (91%).
CONCLUSIONS:
Catheter-based septal ablation is an effective non-surgical technique for reducing symptoms and outflow gradients in HOCM. The proposed scoring system appears to reliably discriminate pts. with a high risk for permanent PM dependency from those with stable AV conduction after PTSMA. Pts. with left bundle branch block at baseline should undergo DDD-PM implantation prior to ablation.
AuthorsLothar Faber, Dirk Welge, Dieter Fassbender, Henning K Schmidt, Dieter Horstkotte, Hubert Seggewiss
JournalInternational journal of cardiology (Int J Cardiol) Vol. 119 Issue 2 Pg. 163-7 (Jul 10 2007) ISSN: 1874-1754 [Electronic] Netherlands
PMID17067708 (Publication Type: Journal Article)
Chemical References
  • Contrast Media
  • Polysaccharides
  • SHU 508
  • Ethanol
Topics
  • Analysis of Variance
  • Cardiomyopathy, Hypertrophic (diagnostic imaging, drug therapy)
  • Contrast Media
  • Echocardiography, Doppler
  • Ethanol (administration & dosage)
  • Female
  • Heart Block (chemically induced, prevention & control)
  • Heart Septum
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Polysaccharides
  • Risk Factors
  • Treatment Outcome

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