Low incidence of procedure-related major adverse cardiac events after alcohol septal ablation for symptomatic hypertrophic obstructive cardiomyopathy
Language English Country Great Britain, England Media print-electronic
Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
PubMed
23927866
DOI
10.1016/j.cjca.2013.04.027
PII: S0828-282X(13)00263-8
Knihovny.cz E-resources
- MeSH
- Ablation Techniques adverse effects MeSH
- Atrioventricular Block etiology surgery MeSH
- Bundle-Branch Block etiology MeSH
- Ethanol therapeutic use MeSH
- Cardiomyopathy, Hypertrophic surgery MeSH
- Pacemaker, Artificial MeSH
- Middle Aged MeSH
- Humans MeSH
- Multivariate Analysis MeSH
- Follow-Up Studies MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Heart Septum surgery MeSH
- Age Factors MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- Ethanol MeSH
BACKGROUND: Alcohol septal ablation (ASA) is a catheter-based intervention that has been used as an alternative to surgical myectomy in highly symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). However, clinically relevant complications can result, including death and complete heart block (CHB) associated with syncope or resuscitation. This study was designed to evaluate the incidence of major ASA-related adverse cardiac events. METHODS: This international multicentre retrospective study included 421 patients in 8 European centres who were treated using ASA from April 1998 to January 2011. Clinical and echocardiographic follow-up (3-6 months) was completed in 394 patients (94%). RESULTS: ASA led to a significant reduction in symptoms and outflow gradients, with 0.7% mortality. A total of 70 patients (17%) experienced mostly transient CHB during and after the procedure; in 30% of them, CHB occurred or recurred later than 24 hours after ASA. Ninety-seven percent of CHB occurred up to the fifth day after ASA. Permanent pacemakers for CHB were implanted in 35 patients (8%). Multivariate analysis identified intraprocedural bundle branch block and age as independent predictors of CHB. CONCLUSIONS: The results of the multicentre study demonstrate that ASA appears safe and efficacious, with low early mortality. The most frequent major complication after ASA was CHB (17%), which occurred late or was recurrent in almost one-third of these patients; 8% of patients required permanent pacemaker implantation. Independent predictors of CHB development were intraprocedural bundle branch block and age. Difficulty in predicting CHB should lead to close postprocedural monitoring and hospital stays lasting at least 5 days.
References provided by Crossref.org
How to Treat Obstructions in Patients with Hypertrophic Cardiomyopathy
