| Percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy: managing the risk of procedure-related AV conduction disturbances. | |
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MedLine Citation:
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PMID: 17067708 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIM: 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. |
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Authors:
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Lothar Faber; Dirk Welge; Dieter Fassbender; Henning K Schmidt; Dieter Horstkotte; Hubert Seggewiss |
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Publication Detail:
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Type: Journal Article Date: 2006-10-24 |
Journal Detail:
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Title: International journal of cardiology Volume: 119 ISSN: 1874-1754 ISO Abbreviation: Int. J. Cardiol. Publication Date: 2007 Jul |
Date Detail:
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Created Date: 2007-06-04 Completed Date: 2007-06-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8200291 Medline TA: Int J Cardiol Country: Netherlands |
Other Details:
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Languages: eng Pagination: 163-7 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany. lfaber@hdz-nrw.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Analysis of Variance Cardiomyopathy, Hypertrophic / drug therapy*, ultrasonography Contrast Media Echocardiography, Doppler Ethanol / administration & dosage* Female Heart Block / chemically induced*, prevention & control* Heart Septum Humans Logistic Models Male Middle Aged Polysaccharides / diagnostic use Risk Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Contrast Media; 0/Polysaccharides; 127279-08-7/SHU 508; 64-17-5/Ethanol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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