Risk of arrhythmic events after alcohol septal ablation for hypertrophic cardiomyopathy using continuous implantable cardiac monitoring

Bleszynski, Peter A.; Goldenberg, Ilan; Fernandez, Genaro; Howell, Erik H.; Younis, Arwa; Chen, Anita Y.; McNitt, Scott; Bruckel, Jeffrey; Ling, Fred S.; Cove, Chris; Aktaş, Mehmet K.

doi:10.1016/j.hrthm.2020.08.013

Cited by 8 publications

(9 citation statements)

References 28 publications

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“…37 Researchers reported that the frequency of AF can reach 37% from the data obtained by examining the post-ASA records of patients with permanent pacemakers. 38 In this study, 2 (8%) patients demonstrated permanent AF, and one patient demonstrated paroxysmal AF before the procedure. Also, no statistically significant increase was found in the frequency of AF during the follow-up (P >0.05).…”

Section: Discussionmentioning

confidence: 57%

Predictive Value of the SCORE, SCORE2, and Pooled Cohort Risk Equation Systems in Patients with Hypertension

Asil¹

2023

Arch Turk Soc Cardiol

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Objective: Surgical septal myectomy and alcohol septal ablation are recommended treatment modalities for alleviating Left ventricular outflow tract (LVOT) gradient in obstructive HCM.Alcohol septal ablation offers advantages over surgery in many ways. However, it is associated with some life-threatening complications. For this purpose, our center used alternative agents for septal artery embolization. This study compared and evaluated conduction system defects and arrhythmia risk after EVOH-DMSO septal ablation with other alternative agents and alcohol septal ablation.Methods: Twenty-five patients who received septal reduction therapy with EVOH-DMSO were analyzed retrospectively, and all non-alcoholic agent's septal ablation studies were systematically reviewed and compared.Results: Twenty-five patients (52% female; mean age: 55.8 ± 17.1) with symptomatic obstructive HCM were enrolled. The Peak LVOT gradient was significantly reduced after the procedure (68 vs. 20 mmHg; P <0.001). During the 12-month follow-up, no mortality occurred.The complete atrioventricular block was noted in 2 (8%) patients. The incidence of right bundle branch block (RBBB) increased after the procedure (pre-procedural 2 patients (8%), post-procedural 9 patients (36%) P = 0.002). On ECG and Holter monitorization, no sustained ventricular tachyarrhythmia occurred during follow-up, and no change was found in the frequency of atrial fibrillation. We systematically compared EVOH-DMSO to other non-alcohol agents, and we found that EVOH-DMSO can cause conduction system problems more commonly than other non-alcohol agents.Conclusion: EVOH-DMSO could cause conduction system problems more common than other non-alcohol agents but less than alcohol septal ablation.

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Section: Discussionmentioning

confidence: 57%

Predictive Value of the SCORE, SCORE2, and Pooled Cohort Risk Equation Systems in Patients with Hypertension

Asil¹

2023

Arch Turk Soc Cardiol

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“…However, whether ASA has a pathophysiological association with future development of atrial fibrillation is unknown. In this patient cohort, the cumulative rate of complete heart block detected by the implantable cardiac monitor within 18 months was 19%, which was mostly due to the injection of alcohol into septal perforators, resulting in injury to the His-Purkinje conduction system (41).…”

Section: Asamentioning

confidence: 88%

Non-pharmaceutical Interventions for Hypertrophic Cardiomyopathy: A Mini Review

Qiu

Bai

et al. 2021

Front. Cardiovasc. Med.

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Hypertrophic cardiomyopathy is an inherited cardiovascular disease, and 70% of patients have left ventricular outflow tract obstruction. Ventricular septal myectomy has been the gold standard treatment for most patients with refractory symptoms. Due to higher mortality associated with medical facilities with less experience, alcohol septal ablation has been accepted as an alternative to conventional surgical myectomy. It offers lower all-cause in-hospital complications and mortality, which could be potentially more preferable for patients with serious comorbidities. In recent years, radiofrequency ablation, providing another option with reproducibility and a low risk of permanent atrioventricular block, has become an effective invasive treatment to relieve left ventricular outflow tract obstruction. Moreover, substantial progress has been made in gene therapy for hypertrophic cardiomyopathy. The principal objective of this review is to present recent advances in non-pharmaceutical interventions in hypertrophic cardiomyopathy.

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“…19 Other arrhythmic complications of ASA include supraventricular tachycardia, ventricular tachycardia, and bradyarrhthmias. 26 Patients undergoing ASA have intraprocedural or follow-up rates of ventricular arrhythmias between 1.8% and 7%. 24,[26][27][28] Finally, a predictor of poor outcomes is the need for a repeat ASA, which may be required in 7% to 13% of patients.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Intramyocardial Septal Radiofrequency Ablation in Patients With Drug-Refractory Hypertrophic Obstructive Cardiomyopathy

Zhou

Hahn

et al. 2022

JAMA Cardiol

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IMPORTANCEPatients with hypertrophic obstructive cardiomyopathy (HOCM) and drug-refractory symptoms and outflow gradients have limited nonsurgical treatment options. The feasibility of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) has been reported previously; however, procedural and medium-term outcomes are unknown.OBJECTIVE To describe the safety and medium-term outcomes of PIMSRA in a large patient cohort with drug-refractory HOCM. DESIGN, SETTING, AND PARTICIPANTSThis was a single-arm, open-label study of PIMSRA in patients with drug-refractory HOCM. Patients presenting to the Xijing Hospital in Xi'an, China, between October 2016 to June 2020 with hypertrophic cardiomyopathy. Of 1314 patients presenting with HOCM, 244 fulfilled inclusion criteria of severe resting/provoked outflow gradients of 50 mm Hg or higher, and symptoms of New York Heart Association functional class of II or higher refractory to maximum tolerated medications. After discussion among the heart team, 40 patients underwent surgical or alcohol septal reduction therapy and 4 required treatment of significant coronary artery disease. INTERVENTIONS PIMSRA performed in patients. MAIN OUTCOMES AND MEASURESThe primary outcome was 30-day major adverse clinical events: death, emergency surgery, severe effusion requiring intervention, procedure-related stroke, bleeding, and stroke. Secondary outcomes included 30-day technical success and 90-day improvement in outflow obstruction. RESULTSThe mean (SD) age of 200 patients was 46.9 (14.0) years, and 125 (62.5%) were men. Resting or provoked left ventricular outflow tract gradients were 50 mm Hg or higher. The median (IQR) follow-up for all patients was 19 (6-50) months. Thirty-day major adverse clinical events rate was 10.5% (n = 21): there were 2 in-hospital/30-day deaths (1.0%), 7 patients (3.5%) with pericardial effusion requiring mini-thoracotomy, 12 patients (6%) with pericardial effusion requiring pericardiocentesis, and no bleeding or strokes. Other periprocedural complications included permanent right bundle branch block in 5 patients (2.5%), resuscitated ventricular fibrillation in 2 (1.0%), and septal branch aneurysm in 2 (1.0%). There were no permanent pacemaker implantations. At follow-up, maximum septal thickness was reduced from a mean (SD) of 24.0 (5.1) mm to 17.3 (4.4) mm (P < .001), and left ventricular outflow tract gradient was decreased from a mean (SD) of 79.0 (53.0) mm Hg to 14.0 (24.0) mm Hg (P < .001). Overall, 190 patients (96%) with HOCM were in New York Heart Association functional class I or II at last follow-up.CONCLUSIONS AND RELEVANCE This study found that PIMSRA in patients with drug-refractory HOCM may be an effective procedure for relief of left ventricular outflow tract obstruction and symptoms with acceptable complication rates. These results are encouraging and support the design of a randomized clinical trial against well-established septal reduction therapies.

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Risk of arrhythmic events after alcohol septal ablation for hypertrophic cardiomyopathy using continuous implantable cardiac monitoring

Cited by 8 publications

References 28 publications

Predictive Value of the SCORE, SCORE2, and Pooled Cohort Risk Equation Systems in Patients with Hypertension

Predictive Value of the SCORE, SCORE2, and Pooled Cohort Risk Equation Systems in Patients with Hypertension

Non-pharmaceutical Interventions for Hypertrophic Cardiomyopathy: A Mini Review

Percutaneous Intramyocardial Septal Radiofrequency Ablation in Patients With Drug-Refractory Hypertrophic Obstructive Cardiomyopathy

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