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Atrioventricular conduction after alcohol septal ablation for obstructive hypertrophic cardiomyopathy

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@article{9d49b1156dc24e21a62f5795e3be4af1,
title = "Atrioventricular conduction after alcohol septal ablation for obstructive hypertrophic cardiomyopathy",
abstract = "AIMS: Lesion of the atrioventricular conduction system is a well known adverse effect of alcohol septal ablation (ASA) in patients with obstructive hypertrophic cardiomyopathy (HCM). We assessed the atrioventricular conduction at long-term follow-up after ASA.METHODS: In patients with a pacemaker implanted for high-grade atrioventricular block after ASA, the atrioventricular conduction was assessed prospectively by ECGs and 48-h Holter recordings. In the remaining patients, the atrioventricular conduction was analysed retrospectively for comparison.RESULTS: A total of 24 (28%) of 87 patients with obstructive HCM without a pacemaker at baseline had a pacemaker implanted due to high-grade atrioventricular block after ASA. Ten of these patients were not available for follow-up. Holter recordings in the remaining 14 patients revealed normalized atrioventricular conduction in 6 patients 6.2 years (range 2.1-9.4) after ASA. Patients with high-grade atrioventricular block at follow-up had longer PR intervals at baseline [205 ms (200-230)] than the rest of the cohort [180 ms (140-200), P = 0.004] and a higher incidence of acute complete heart block (63 vs. 15%; P = 0.007) during ASA. A PR interval of at least 200 ms at baseline was associated with higher prevalence of high-grade atrioventricular block at follow-up (30 vs. 2%; P = 0.0013). The incidence of late-onset complete heart block was 1.5% per year after ASA.CONCLUSION: We found normalized atrioventricular conduction at long-term follow-up, suggesting recovery in 6 of 14 patients with a pacemaker implanted in relation to ASA. Permanent atrioventricular conduction abnormalities were associated with baseline PR intervals of at least 200 ms and acute persistent complete heart block during ASA.",
keywords = "Ablation Techniques, Aged, Atrioventricular Block, Cardiomyopathy, Hypertrophic, Electrocardiography, Ethanol, Female, Follow-Up Studies, Heart Conduction System, Humans, Male, Middle Aged, Pacemaker, Artificial, Prospective Studies",
author = "Anna Axelsson and Kristina Weibring and Ole Havndrup and Henning Kelb{\ae}k and Erik J{\o}rgensen and Steffen Helqvist and Kasper Iversen and Lars K{\o}ber and Henning Bundgaard and Jensen, {Morten Kvistholm}",
year = "2014",
month = mar,
doi = "10.2459/JCM.0b013e3283638073",
language = "English",
volume = "15",
pages = "214--21",
journal = "Journal of Cardiovascular Medicine",
issn = "1558-2027",
publisher = "Lippincott Williams & Wilkins",
number = "3",

}

RIS

TY - JOUR

T1 - Atrioventricular conduction after alcohol septal ablation for obstructive hypertrophic cardiomyopathy

AU - Axelsson, Anna

AU - Weibring, Kristina

AU - Havndrup, Ole

AU - Kelbæk, Henning

AU - Jørgensen, Erik

AU - Helqvist, Steffen

AU - Iversen, Kasper

AU - Køber, Lars

AU - Bundgaard, Henning

AU - Jensen, Morten Kvistholm

PY - 2014/3

Y1 - 2014/3

N2 - AIMS: Lesion of the atrioventricular conduction system is a well known adverse effect of alcohol septal ablation (ASA) in patients with obstructive hypertrophic cardiomyopathy (HCM). We assessed the atrioventricular conduction at long-term follow-up after ASA.METHODS: In patients with a pacemaker implanted for high-grade atrioventricular block after ASA, the atrioventricular conduction was assessed prospectively by ECGs and 48-h Holter recordings. In the remaining patients, the atrioventricular conduction was analysed retrospectively for comparison.RESULTS: A total of 24 (28%) of 87 patients with obstructive HCM without a pacemaker at baseline had a pacemaker implanted due to high-grade atrioventricular block after ASA. Ten of these patients were not available for follow-up. Holter recordings in the remaining 14 patients revealed normalized atrioventricular conduction in 6 patients 6.2 years (range 2.1-9.4) after ASA. Patients with high-grade atrioventricular block at follow-up had longer PR intervals at baseline [205 ms (200-230)] than the rest of the cohort [180 ms (140-200), P = 0.004] and a higher incidence of acute complete heart block (63 vs. 15%; P = 0.007) during ASA. A PR interval of at least 200 ms at baseline was associated with higher prevalence of high-grade atrioventricular block at follow-up (30 vs. 2%; P = 0.0013). The incidence of late-onset complete heart block was 1.5% per year after ASA.CONCLUSION: We found normalized atrioventricular conduction at long-term follow-up, suggesting recovery in 6 of 14 patients with a pacemaker implanted in relation to ASA. Permanent atrioventricular conduction abnormalities were associated with baseline PR intervals of at least 200 ms and acute persistent complete heart block during ASA.

AB - AIMS: Lesion of the atrioventricular conduction system is a well known adverse effect of alcohol septal ablation (ASA) in patients with obstructive hypertrophic cardiomyopathy (HCM). We assessed the atrioventricular conduction at long-term follow-up after ASA.METHODS: In patients with a pacemaker implanted for high-grade atrioventricular block after ASA, the atrioventricular conduction was assessed prospectively by ECGs and 48-h Holter recordings. In the remaining patients, the atrioventricular conduction was analysed retrospectively for comparison.RESULTS: A total of 24 (28%) of 87 patients with obstructive HCM without a pacemaker at baseline had a pacemaker implanted due to high-grade atrioventricular block after ASA. Ten of these patients were not available for follow-up. Holter recordings in the remaining 14 patients revealed normalized atrioventricular conduction in 6 patients 6.2 years (range 2.1-9.4) after ASA. Patients with high-grade atrioventricular block at follow-up had longer PR intervals at baseline [205 ms (200-230)] than the rest of the cohort [180 ms (140-200), P = 0.004] and a higher incidence of acute complete heart block (63 vs. 15%; P = 0.007) during ASA. A PR interval of at least 200 ms at baseline was associated with higher prevalence of high-grade atrioventricular block at follow-up (30 vs. 2%; P = 0.0013). The incidence of late-onset complete heart block was 1.5% per year after ASA.CONCLUSION: We found normalized atrioventricular conduction at long-term follow-up, suggesting recovery in 6 of 14 patients with a pacemaker implanted in relation to ASA. Permanent atrioventricular conduction abnormalities were associated with baseline PR intervals of at least 200 ms and acute persistent complete heart block during ASA.

KW - Ablation Techniques

KW - Aged

KW - Atrioventricular Block

KW - Cardiomyopathy, Hypertrophic

KW - Electrocardiography

KW - Ethanol

KW - Female

KW - Follow-Up Studies

KW - Heart Conduction System

KW - Humans

KW - Male

KW - Middle Aged

KW - Pacemaker, Artificial

KW - Prospective Studies

U2 - 10.2459/JCM.0b013e3283638073

DO - 10.2459/JCM.0b013e3283638073

M3 - Journal article

C2 - 24662414

VL - 15

SP - 214

EP - 221

JO - Journal of Cardiovascular Medicine

JF - Journal of Cardiovascular Medicine

SN - 1558-2027

IS - 3

ER -

ID: 45027800