Temporal Occurrence of Arrhythmic Complications After Alcohol Septal Ablation
Bassim El-Sabawi1, Rick A Nishimura2, Gregory W Barsness2
1Department of Medicine (B.E.-S.), Mayo Clinic, Rochester, MN.
Insights
Most complete heart block (CHB) and ventricular tachyarrhythmia (VT) after alcohol septal ablation (ASA) occur within 24 hours. Early discharge may be safe for patients without baseline conduction issues.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- The timing of arrhythmic complications following alcohol septal ablation (ASA) for hypertrophic cardiomyopathy is not well-defined.
- This uncertainty leads to controversy regarding optimal patient monitoring duration post-ASA.
Purpose of the Study:
- To investigate the temporal patterns of complete heart block (CHB) and ventricular tachyarrhythmia (VT) after ASA.
- To inform safe discharge criteria and post-procedural monitoring strategies.
Main Methods:
- Retrospective review of 243 patients undergoing ASA for hypertrophic cardiomyopathy (2003-2019).
- Assessment of the incidence and timing of CHB or sustained VT within 30 days post-ASA.
Main Results:
- CHB occurred in 24.3% of patients, with 21.0% presenting within 24 hours post-ASA.
- Only 2.4% of CHB cases occurred after 72 hours; VT incidence was low (1.2%).
- Baseline bundle branch block and age ≥70 were associated with CHB, but not late-onset CHB.
Conclusions:
- The low incidence of CHB or VT after 72 hours suggests a potential for earlier patient discharge.
- Timely discharge may be safe for patients without early conduction disturbances post-ASA.
- Consideration for early discharge is particularly relevant for patients without pre-existing conduction abnormalities.
Background:
The temporal occurrence of arrhythmic complications after alcohol septal ablation (ASA) is unclear. As a result, the appropriate time to monitor patients after ASA is controversial. The purpose of this study is to determine the temporal occurrence of complete heart block (CHB) and ventricular tachyarrhythmia (VT) after ASA to better understand when patients can be safely discharged.
Methods:
Consecutive patients treated with ASA for hypertrophic cardiomyopathy from 2003 to 2019 at a tertiary referral center were reviewed retrospectively. The incidence and timing of CHB or sustained VT within 30 days post-ASA were assessed.
Results:
A total of 243 patients were included in this study. Mean maximal septal thickness was 19.0±3.9 mm, and total volume of ethanol injected was 1.7±0.6 mL. CHB occurred in 59 (24.3%) patients, including transient CHB in 33 (13.6%) and permanent in 26 (10.7%). The initial episode of CHB occurred within 24 hours post-ASA in 51 (21.0%) patients, between 24 and 48 hours in 3 (1.2%), between 48 and 72 hours in 3 (1.2%), and after 72 hours in 2 (0.8%). New permanent pacemaker was placed in 46 (18.3%). Presence of baseline bundle branch block and age ≥70 were significantly associated with CHB but not CHB presenting after 24 hours. VT occurred in 3 (1.2%) patients, including 1 (0.4%) within 24 hours, 1 (0.4%) between 24 and 48 hours, and 1 (0.4%) after 72 hours. VT required cardioversion in 2 patients and new implantable cardioverter-defibrillator placement in 2.
Conclusions:
The incidence of CHB or VT presenting after 72 hours post-ASA was low. These findings suggest that timely discharge of patients without evidence of early conduction disturbances after ASA can be considered as a potentially safe management strategy, especially in patients without preexisting conduction abnormalities.
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