Outcomes of Patients With Hypertrophic Obstructive Cardiomyopathy and Pacemaker Implanted After Alcohol Septal
Josef Veselka1, Max Liebregts2, Robert Cooper3
1Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic.
Insights
Alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy can lead to high-grade atrioventricular block requiring permanent pacemaker (PPM) implantation in 9% of patients. Long-term outcomes for patients with PPM are comparable to those without, with improved gradient reduction and fewer reinterventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Atrioventricular block is a significant complication following alcohol septal ablation (ASA).
- Hypertrophic obstructive cardiomyopathy (HOCM) is a condition often treated with ASA.
Purpose of the Study:
- To assess the long-term outcomes of patients with HOCM who received a permanent pacemaker (PPM) after developing high-grade atrioventricular block post-ASA.
- To compare the clinical status and survival rates between HOCM patients with and without PPM after ASA.
Main Methods:
- Utilized the multinational Euro-ASA registry data.
- Included 1,814 patients undergoing ASA, with a focus on 170 (9.4%) requiring PPM within 30 days.
- Employed propensity score matching to create comparable PPM and non-PPM groups (n=278).
Main Results:
- No significant long-term differences in survival or New York Heart Association functional class between matched PPM and non-PPM groups.
- Patients with PPM demonstrated a lower long-term left ventricular (LV) outflow gradient and a more pronounced decrease in the gradient.
- The PPM group experienced a lower LV ejection fraction and a reduced likelihood of requiring reintervention (re-ASA or myectomy).
Conclusions:
- Approximately 9% of HOCM patients treated with ASA require PPM due to high-grade atrioventricular block.
- PPM implantation after ASA does not negatively impact long-term survival or functional class in HOCM patients.
- PPM is associated with favorable long-term hemodynamic results, including reduced LV outflow gradient and fewer reinterventions.
Background:
Atrioventricular block is a frequent major complication after alcohol septal ablation (ASA).
Objectives:
The aim of this study was to evaluate the outcomes of patients with implanted permanent pacemaker (PPM) related to a high-grade atrioventricular block after ASA for hypertrophic obstructive cardiomyopathy.
Methods:
We used a multinational registry (the Euro-ASA registry) to evaluate the outcome of patients with PPM after ASA.
Results:
A total of 1,814 patients were enrolled and followed up for 5.0 ± 4.3 years (median = 4.0 years). A total of 170 (9.4%) patients underwent PPM implantation during the first 30 days after ASA. Using propensity score matching, 139 pairs (n = 278) constituted the matched PPM and non-PPM groups. Between the matched groups, there were no long-term differences in New York Heart Association functional class (1.5 ± 0.7 vs 1.5 ± 0.9, P = 0.99) and survival (log-rank P = 0.47). Patients in the matched PPM group had lower long-term left ventricular (LV) outflow gradient (12 ± 12 mm Hg vs 17 ± 19 mm Hg, P < 0.01), more pronounced LV outflow gradient decrease (81% ± 17% vs 72% ± 35%, P < 0.01), and lower LV ejection fraction (64% ± 8% vs 66% ± 8%, P = 0.02) and were less likely to undergo reintervention (re-ASA or myectomy) (log-rank P = 0.02).
Conclusions:
Patients with hypertrophic obstructive cardiomyopathy treated with ASA have a 9% probability of PPM implantation within 30 days after ASA. In long-term follow-up, patients with PPM had similar long-term survival and New York Heart Association functional class but lower LV outflow gradient, a more pronounced LV outflow gradient decrease, a lower LV ejection fraction, and a lower likelihood of reintervention compared with patients without PPM.
More Related Videos
Related Concept Videos
01:29Cardiomyopathy V: Interprofessional Care
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:26Mitral Stenosis III: Medical Management