Document Detail


Is alcohol ablation of the septum associated with recurrent tachyarrhythmias?
MedLine Citation:
PMID:  18058274     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
QUESTIONS UNDER STUDY: Alcohol ablation (AA) of the septum has been introduced as new therapy in hypertrophic cardiomyopathy (HCM). It was feared that iatrogenic myocardial infarction due to AA may induce re-entry tachyarrhythmias and increase sudden cardiac death.
METHODS AND RESULTS: Twenty-four patients (mean age 52 years) underwent successful AA. Clinical follow-up (FU) ranged from 0.3 to 0.7 years (mean 2.8). One patient died (suicide) 4 years after AA. Left ventricular (LV) outflow gradient (peak-to-peak) decreased (median) after AA from 43 (IQR 25 to 4) mmHg to 1 (IQR 0 to 12) mmHg (rest) (p <0.001) and from 130 (IQR 75 to 165) mmHg to 13 (IQR 0 to 31) mmHg (postextrasystolic) (p <0.001). Transient AV block occurred in 22% (5/24) necessitating temporary pacing. A permanent pacemaker was implanted in 4% (1/24). NYHA-class was 2.5 (IQR 2.0 to 3.0) before and 1.5 (IQR 1.3 to 2.0) (p <0.001) after AA. During FU, 2 pacemakers were implanted due to bradycardia (no AV block). A right bundle branch block was found in 13% (2/24) before and 46 % (11/24) after AA (p = 0.003). Non-sustained ventricular tachycardia (NSVT) was observed in 13% (2/16) before and 22% (5/23) (p = 0.46) after AA. Two patients required ICD implantation.
CONCLUSIONS: Long-term FU is excellent in HCM after AA. The pressure gradient drops below 25 mm Hg in 95% (23/24) of all patients. Transient AV block occurs in 22% (5/24), but permanent pacemaker implantation is rarely needed (13%, 2/24). Severe NSVT occurs in 13% (2/16) before and 22% (5/23) after AA but ICD implantation is only occasionally required.
Authors:
Sven Streit; Nazan Walpoth; Stephan Windecker; Bernhard Meier; Otto Hess
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Swiss medical weekly     Volume:  137     ISSN:  1424-7860     ISO Abbreviation:  Swiss Med Wkly     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2007-12-06     Completed Date:  2008-02-01     Revised Date:  2011-02-15    
Medline Journal Info:
Nlm Unique ID:  100970884     Medline TA:  Swiss Med Wkly     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  660-8     Citation Subset:  IM    
Affiliation:
Swiss Cardiovascular Center, University Hospital, Inselspital, Berne, Switzerland. svenstreit@bluewin.ch
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cardiomyopathy, Hypertrophic / surgery
Catheter Ablation / methods*
Echocardiography
Ethanol / administration & dosage*
Female
Heart Septum / surgery*
Humans
Male
Middle Aged
Outcome Assessment (Health Care)
Recurrence
Switzerland
Tachycardia / surgery*
Chemical
Reg. No./Substance:
64-17-5/Ethanol
Comments/Corrections
Comment In:
Swiss Med Wkly. 2008 May 31;138(21-22):322; author reply 322-3   [PMID:  18578089 ]
Swiss Med Wkly. 2007 Dec 1;137(47-48):657-9   [PMID:  18058273 ]

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