AIMS: We analysed the impact of bundle branch block (BBB) and pacemaker (PM) implantation on symptoms and survival after alcohol septal ablation (ASA) in patients with hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS: Among 1416 HCM patients from the Euro-ASA registry, 58 (4%) patients had a PM and 64 (5%) patients had an implantable cardioverter-defibrillator (ICD) before ASA. At latest follow-up (5.0 ± 4.0 years) after ASA, 118 (8%) patients had an ICD and 229 (16%) patients had a PM. In patients without an implantable device prior to ASA 13% had a PM and 5% had an ICD implanted following ASA. New onset BBB was present in 44% (right BBB in 31%) of patients without previous BBB. At latest follow-up, we found no associations between BBB and New York Heart Association (NYHA) Class 3-4 [odds ratio (OR) 0.98, 95% confidence interval (CI) 0.63-1.51; P = 0.91] or Canadian Cardiovascular Society (CCS) Class 3-4 (OR 1.5, CI 0.32-6.7; P = 0.62), respectively, and no associations between PM and NYHA Class 3-4 (OR 1.2, CI 0.70-2.0; P = 0.52) or CCS 3-4 (OR 1.3, CI 0.24-6.6; P = 0.79), respectively. The survival after ASA was not reduced in patients with BBB [hazard ratio (HR) 0.73, CI 0.53-1.01; P = 0.06] or PM (HR 0.78, CI 0.52-1.17; P = 0.24). CONCLUSIONS: Development of BBB or need for a PM after ASA in patients with obstructive HCM was not associated with inferior symptomatic outcome or reduced survival, thus concerns for the negative impact of impaired cardiac conduction on the clinical outcome after ASA were not confirmed.

1st Department of Internal Medicine Cardioangiology International Clinical Research Centre St Anne's University Hospital and Masaryk University Brno Czech Republic

Cardiocentre Podlesí Třinec Czech Republic

Clinic for Cardiology Herz und Diabeteszentrum NRW Ruhr Universität Bochum Bad Oeynhausen Germany

Department of Cardiology 2nd Medical School Charles University University Hospital Motol Prague Czech Republic

Department of Cardiology Herlev and Gentofte Hospital Hellerup Denmark

Department of Cardiology Oslo University Hospital Oslo Norway

Department of Cardiology St Antonius Hospital Nieuwegein Nieuwegein the Netherlands

Department of Internal Medicine 3 Medical University Innsbruck Innsbruck Austria Heart and Vascular Institute Cleveland Clinic Abu Dhabi United Arab Emirates

Department of Interventional Cardiology and Angiology Institute of Cardiology Warsaw Poland

Institute of Cardiovascular Medicine and Science Liverpool Heart and Chest Hospital Liverpool England

Klinikum Würzburg Mitte Juliusspital Würzburg Germany

Unit for Inherited Cardiac Diseases Department of Cardiology Copenhagen University Hospital Rigshospitalet University of Copenhagen Copenhagen Denmark

Unit for Inherited Cardiac Diseases Department of Cardiology Copenhagen University Hospital Rigshospitalet University of Copenhagen Copenhagen Denmark Department of cardiology Aarhus University Hospital Aarhus Denmark

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$a Jensen, Morten Kvistholm $u Unit for Inherited Cardiac Diseases, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Department of cardiology, Aarhus University Hospital, Aarhus, Denmark.

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$a Effect of impaired cardiac conduction after alcohol septal ablation on clinical outcomes: insights from the Euro-ASA registry / $c MK. Jensen, L. Faber, M. Liebregts, J. Januska, J. Krejci, T. Bartel, RM. Cooper, M. Dabrowski, PR. Hansen, VM. Almaas, H. Seggewiss, D. Horstkotte, R. Adlova, JT. Berg, H. Bundgaard, J. Veselka,

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$a AIMS: We analysed the impact of bundle branch block (BBB) and pacemaker (PM) implantation on symptoms and survival after alcohol septal ablation (ASA) in patients with hypertrophic cardiomyopathy (HCM). METHODS AND RESULTS: Among 1416 HCM patients from the Euro-ASA registry, 58 (4%) patients had a PM and 64 (5%) patients had an implantable cardioverter-defibrillator (ICD) before ASA. At latest follow-up (5.0 ± 4.0 years) after ASA, 118 (8%) patients had an ICD and 229 (16%) patients had a PM. In patients without an implantable device prior to ASA 13% had a PM and 5% had an ICD implanted following ASA. New onset BBB was present in 44% (right BBB in 31%) of patients without previous BBB. At latest follow-up, we found no associations between BBB and New York Heart Association (NYHA) Class 3-4 [odds ratio (OR) 0.98, 95% confidence interval (CI) 0.63-1.51; P = 0.91] or Canadian Cardiovascular Society (CCS) Class 3-4 (OR 1.5, CI 0.32-6.7; P = 0.62), respectively, and no associations between PM and NYHA Class 3-4 (OR 1.2, CI 0.70-2.0; P = 0.52) or CCS 3-4 (OR 1.3, CI 0.24-6.6; P = 0.79), respectively. The survival after ASA was not reduced in patients with BBB [hazard ratio (HR) 0.73, CI 0.53-1.01; P = 0.06] or PM (HR 0.78, CI 0.52-1.17; P = 0.24). CONCLUSIONS: Development of BBB or need for a PM after ASA in patients with obstructive HCM was not associated with inferior symptomatic outcome or reduced survival, thus concerns for the negative impact of impaired cardiac conduction on the clinical outcome after ASA were not confirmed.

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$a Faber, Lothar $u Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.

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$a Liebregts, Max $u Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands.

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$a Januska, Jaroslav $u Cardiocentre Podlesí, Třinec, Czech Republic.

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$a Krejci, Jan $u 1st Department of Internal Medicine/Cardioangiology, International Clinical Research Centre, St. Anne's University Hospital and Masaryk University, Brno, Czech Republic.

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$a Bartel, Thomas $u Department of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria. Heart & Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.

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$a Cooper, Robert M $u Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, England.

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$a Dabrowski, Maciej $u Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.

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$a Hansen, Peter Riis $u Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark.

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$a Almaas, Vibeke Marie $u Department of Cardiology, Oslo University Hospital, Oslo, Norway.

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$a Seggewiss, Hubert $u Klinikum Würzburg-Mitte, Juliusspital, Würzburg, Germany.

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$a Horstkotte, Dieter $u Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.

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$a Adlova, Radka $u Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic.

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$a Berg, Jurriën Ten $u Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands.

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$a Bundgaard, Henning $u Unit for Inherited Cardiac Diseases, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

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$a Veselka, Josef $u Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic.

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