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Rigshospitalet - a part of Copenhagen University Hospital
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Atrioventricular conduction after alcohol septal ablation for obstructive hypertrophic cardiomyopathy

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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.

Original languageEnglish
JournalJournal of Cardiovascular Medicine (Hagerstown)
Volume15
Issue number3
Pages (from-to)214-21
Number of pages8
ISSN1558-2027
DOIs
Publication statusPublished - Mar 2014

    Research areas

  • Ablation Techniques, Aged, Atrioventricular Block, Cardiomyopathy, Hypertrophic, Electrocardiography, Ethanol, Female, Follow-Up Studies, Heart Conduction System, Humans, Male, Middle Aged, Pacemaker, Artificial, Prospective Studies

ID: 45027800