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Permanent pacemaker implantation after alcoholic septal ablation induced complete heart block: Long-term impact
André Grazina1, Isabel Cardoso1, António Fiarresga1
1Cardiology Department, Hospital de Santa Marta, Lisbon, Portugal.
Insights
Permanent pacemaker implantation after alcohol septal ablation for hypertrophic obstructive cardiomyopathy does not impact long-term outcomes. Patients requiring a pacemaker for complete heart block showed similar mortality and hospitalization rates at three years.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Alcohol septal ablation (ASA) is a treatment for symptomatic hypertrophic obstructive cardiomyopathy (HOCM).
- Complete heart block (CHB) is a common complication of ASA, often necessitating permanent pacemaker (PPM) implantation.
- The long-term effects of PPM in HOCM patients post-ASA are not well understood.
Purpose of the Study:
- To assess the long-term clinical outcomes of HOCM patients who receive a PPM following ASA.
Main Methods:
- A prospective study enrolled HOCM patients undergoing ASA.
- Patients were divided into two groups: those who did and did not require PPM implantation for CHB.
- Outcomes were compared based on baseline characteristics, procedural data, and a three-year composite endpoint of all-cause mortality and hospitalization.
Main Results:
- 16.5% of 97 analyzed patients required PPM implantation for CHB.
- PPM patients were older and had lower beta-blocker use; higher creatine kinase peaks were observed post-procedure.
- No significant differences in three-year mortality or hospitalization rates were found between groups.
Conclusions:
- Permanent pacemaker implantation following ASA-induced CHB in HOCM patients does not appear to negatively affect long-term prognosis.
- This finding suggests that CHB requiring PPM is a manageable complication without compromising long-term survival or hospitalizations.
Introduction And Objectives:
Patients with hypertrophic obstructive cardiomyopathy (HOCM) that remain symptomatic despite optimized medical therapy often undergo alcohol septal ablation (ASA). One of the most frequent complications is complete heart block (CHB), requiring a permanent pacemaker (PPM) in variable rates of up to 20% of patients. The long-term impact of PPM implantation in these patients remains unclear. This study aimed to evaluate the long-term clinical outcomes in patients who implant PPM after ASA.
Methods:
Patients who underwent ASA at a tertiary center were consecutively and prospectively enrolled. Patients with previous PPM or implantable cardio-defibrillator were excluded from this analysis. Patients with and without PPM implantation after ASA were compared based on their baseline characteristics, procedure data and three-year primary endpoint of composite of all-cause mortality and hospitalization and secondary endpoint of composite of all-cause mortality and cardiac cause hospitalization.
Results:
Between 2009 and 2019, 109 patients underwent ASA, 97 of whom were included in this analysis (68% female, mean age 65.2 years old). 16 patients (16.5%) required PPM implantation for CHB. In these patients, no vascular access, pacemaker pocket or pulmonary parenchyma complications were noted. The baseline characteristics of comorbidities, symptoms, echocardiographic and electrocardiographic findings were identical in the two groups, with higher mean age (70.6±10.0 years vs. 64.1±11.9 years) and lower beta-blocker therapy rate (56% vs. 84%) in the PPM group. Procedure-related data showed higher creatine kinase (CK) peaks in the PPM group (1692 U/L vs. 1243 U/L), with no significant difference in the alcohol dose. At three years after ASA procedure, there were no differences in the primary and secondary endpoints between the two groups.
Conclusions:
Permanent pacemaker after ASA induced CHB do not affect long term prognosis in hypertrophic obstructive cardiomyopathy patients.
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