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The risk of non-sustained ventricular tachycardia after percutaneous alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy

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Abstract

Background

Percutaneous alcohol septal ablation (ASA) becomes an alternative option of treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). The procedure relieves left ventricular outflow tract obstruction, but produces a myocardial scar in patients who already have a substrate for life-threatening ventricular arrhythmia.

Objectives

To examine the effect of ASA on the occurrence of non-sustained ventricular tachycardia (nsVT) on 24 h ambulatory Holter monitoring in HOCM patients.

Methods

Sixty-one consecutive patients (34 males, mean age 48 years), who underwent ASA between 1997 and 2003 were analyzed. Holter recordings were performed in each patient before and after ablation.

Results

Follow-up ranged from 60 to 125 months (median 116 months). The mean number of Holter recordings per patient was 2.7 (range 1–11) before and 8.3 (range 2–23) after ASA (p < 0.001). Non-sustained ventricular tachycardia occurred in 14 patients before and 27 patients after ASA (23 vs. 44%, p = 0.01). The percentage of Holter recordings with nsVT before and after ablation was similar (14.5 vs. 15.7%, p = 0.56, respectively). No difference was observed between the number of nsVT per Holter recording before and after ablation (0.21 vs. 0.24%, p = 0.65, respectively). The percentage of patients with nsVT after ASA was comparable to the proportion of patients with nsVT in a control group consisting of 705 patients with hypertrophic cardiomyopathy under follow-up at our institution (44.3 vs. 43.2%, p = 0.91). There was no significant difference in percentage of Holter recordings with nsVT with respect to sex, amount of alcohol used during ASA, peak creatine phosphokinase level, and gradient reduction at rest.

Conclusion

Alcohol septal ablation affected neither the percentage of Holter recordings with nsVT nor the number of nsVT episodes per Holter recording among HOCM patients.

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References

  1. Adabag AS, Maron BJ, Appelbaum E, Harrigan CJ, Buros JL, Gibson CM, Lesser JR, Hanna CA, Udelson JE, Manning WJ, Maron MS (2008) Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance. J Am Coll Cardiol 51:1369–1374

    Article  PubMed  Google Scholar 

  2. Boekstegers P, Steinbigler P, Molnar A, Schwaiblmair M, Becker A, Knez A, Haberl R, Steinbeck G (2001) Pressure-guided nonsurgical myocardial reduction induced by small septal infarctions in hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 38:846–853

    Article  CAS  PubMed  Google Scholar 

  3. Bello D, Fieno DS, Kim RJ, Pereles FS, Passman R, Song G, Kadish AH, Goldberger JJ (2005) Infarct morphology identifies patients with substrate for sustained ventricular tachycardia. J Am Coll Cardiol 45:1104–1108

    Article  PubMed  Google Scholar 

  4. Boltwood CM Jr, Chien W, Ports T (2004) Ventricular tachycardia complicating alcohol septal ablation. N Engl J Med 351:1914–1915

    Article  CAS  PubMed  Google Scholar 

  5. Cecchi F, Olivotto I, Montereggi A, Squillatini G, Dolara A, Maron BJ (1998) Prognostic value of non-sustained ventricular tachycardia and the potential role of amiodarone treatment in hypertrophic cardiomyopathy: assessment in an unselected non-referral based patient population. Heart 79:331–336

    CAS  PubMed  Google Scholar 

  6. Chojnowska L, Ruzyllo W, Witkowski A, Demkow M, Kusmierczyk-Droszcz B, Kepka C, Konka M, Malecka L, Karcz M, Stepinska J (2003) Early and long-term results of non-surgical septal reduction in patients with hypertrophic cardiomyopathy. Kardiol Pol 59:269–282

    PubMed  Google Scholar 

  7. Cuoco FA, Spencer WH III, Fernandes VL, Nielsen CD, Nagueh S, Sturdivant JL, Leman RB, Wharton JM, Gold MR (2008) Implantable cardioverter-defibrillator therapy for primary prevention of sudden death after alcohol septal ablation of hypertrophic cardiomyopathy. J Am Coll Cardiol 52:1718–1723

    Article  PubMed  Google Scholar 

  8. Elliott PM, Gimeno JR, Tome MT, Shan J, Ward D, Thaman R, Mogensen J, McKenna WJ (2006) Left ventricular outflow tract obstruction and sudden death risk in patients with hypertrophic cardiomyopathy. Eur Heart J 27:1933–1941

    Article  PubMed  Google Scholar 

  9. Faber L, Welge D, Fassbender D, Schmidt HK, Horstkotte D, Seggewiss H (2007) One-year follow-up of percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy in 312 patients: predictors of hemodynamic and clinical response. Clin Res Cardiol 96:864–873

    Article  CAS  PubMed  Google Scholar 

  10. Gietzen FH, Leuner CJ, Raute-Kreinsen U, Dellmann A, Hegselmann J, Strunk-Mueller C, Kuhn HJ (1999) Acute and long-term results after transcoronary ablation of septal hypertrophy (TASH). Catheter interventional treatment for hypertrophic obstructive cardiomyopathy. Eur Heart J 20:1342–1354

    Article  CAS  PubMed  Google Scholar 

  11. Kuhn H (1999) Septal ablation in HOCM: is there an arrhythmogenic potential? 11th World Symposium on cardiac pacing and electrophysiology, Berlin 1999

  12. Kuhn H, Gietzen FH, Leuner C, Schäfers M, Schober O, Strunk-Müller C, Obergassel L, Freick M, Gockel B, Lieder F, Raute-Kreinsen U (2000) Transcoronary ablation of septal hypertrophy (TASH): a new treatment option for hypertrophic obstructive cardiomyopathy. Z Kardiol, 89 (Suppl 4) : IV 41–54

    Google Scholar 

  13. Kuhn H, Lawrenz T, Lieder F, Leuner C, Strunk-Mueller C, Obergassel L, Bartelsmeier M, Stellbrink C (2008) Survival after transcoronary ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy (TASH): a 10 year experience. Clin Res Cardiol 97:234–243

    Article  PubMed  Google Scholar 

  14. Kwong RY, Chan AK, Brown KA, Chan CW, Reynolds HG, Tsang S, Davis RB (2006) Impact of unrecognized myocardial scar detected by cardiac resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease. Circulation 113:2733–2743

    Article  PubMed  Google Scholar 

  15. Lawrenz T, Obergassel L, Lieder F, Leuner C, Strunk-Mueller C, Meyer Zu Vilsendorf D, Beer G, Kuhn H (2005) Transcoronary ablation of septal hypertrophy does not alert ICD intervention rates in high risk patients with hypertrophic obstructive cardiomyopathy. Pacing Clin Electrophysiol 28:295–300

    Article  PubMed  Google Scholar 

  16. Malek LA, Chojnowska L, Klopotowski M, Maczynska R, Demkow M, Witkowski A, Kusmierczyk B, Piotrowicz E, Konka M, Dabrowski M, Ruzyllo W (2008) Long term exercise capacity in patients with hypertrophic cardiomyopathy treated with percutaneous transluminal septal myocardial ablation. Eur J Heart Fail 10:1123–1126

    Article  PubMed  Google Scholar 

  17. Maron BJ (2007) Controversies in cardiovascular medicine. Surgical myectomy remains the primary treatment option for severely symptomatic patients with obstructive hypertrophic cardiomyopathy. Circulation 116:196–206

    Article  PubMed  Google Scholar 

  18. Maron BJ, Spirito P, Shen WK, Haas TS, Formisano F, Link MS, Epstein AE, Almquist AK, Daubert JP, Lawrenz T, Boriani G, Estes NA 3rd, Favale S, Piccininno M, Winters SL, Santini M, Betocchi S, Arribas F, Sherrid MV, Buja G, Semsarian C, Bruzzi P (2007) Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy. JAMA 298:405–412

    Article  CAS  PubMed  Google Scholar 

  19. Maron MS, Olivotto I, Zenovich AG, Link MS, Pandian NG, Kuvin JT, Nistri S, Cecchi F, Udelson JE, Maron BJ (2006) Hypertrophic cardiomyopathy is predominantly a disease of left ventricular outflow tract obstruction. Circulation 114:2232–2239

    Article  PubMed  Google Scholar 

  20. Monserrat L, Elliott PM, Gimeno JR, Sharma S, Penas-Lado M, McKenna WJ (2003) Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden death risk in young patients. J Am Coll Cardiol 42:873–879

    Article  PubMed  Google Scholar 

  21. Obergassel L, Lawrenz T, Gietzen FH, Lieder F, Leuner C, Kuhn H, Stellbrink C (2006) Effect of transcoronary ablation of septal hypertrophy on clinical outcome in hypertrophic obstructive cardiomyopathy associated with atrial fibrillation. Clin Res Cardiol 95:254–260

    Article  CAS  PubMed  Google Scholar 

  22. Raute-Kreinsen U (2003) Morphology of necrosis and repair after transcoronary ethanol ablation of septal hypertrophy. Pathol Res Pract 1999:121–127

    Article  Google Scholar 

  23. Ruzyllo W, Chojnowska L, Demkow M, Witkowski A, Kusmierczyk-Droszcz B, Piotrowski W, Rausinska L, Karcz M, Malecka L, Rydlewska-Sadowska W (2000) Left ventricular outflow tract gradient decrease with non-surgical myocardial reduction improves exercise capacity in patients with hypertrophic obstructive cardiomyopathy. Eur Heart J 21:770–777

    Article  CAS  PubMed  Google Scholar 

  24. Seggewiss H, Rigopoulos A, Welge D, Ziemssen P, Faber L (2007) Long-term follow-up after percutaneous septal ablation in hypertrophic obstructive cardiomyopathy. Clin Res Cardiol 96:856–863

    Article  CAS  PubMed  Google Scholar 

  25. Sigwart U (1995) Non-surgical myocardial reduction for hypertrophic obstructive cardiomyopathy. Lancet 346:211–214

    Article  CAS  PubMed  Google Scholar 

  26. Soliman OI, Geleijnse ML, Michels M, Dijkmans PA, Nemes A, van Dalen BM, Vletter WB, Serruys PW, Ten Cate FJ (2008) Effect of successful alcohol septal ablation on microvascular function in patients with obstructive hypertrophic cardiomyopathy. Am J Cardiol 101:1321–1327

    Article  PubMed  Google Scholar 

  27. Streit S, Walpoth N, Windecker S, Meier B, Hess O (2007) Is alcohol ablation of the septum associated with recurrent tachyarrhythmias? Swiss Med Wkly 137:660–668

    PubMed  Google Scholar 

  28. van Dockum WG, Kuijer JP, Gotte MJ, Ten Cate FJ, Ten Berg JM, Beek AM, Twisk JW, Marcus JT, Visser CA, van Rossum AC (2006) Septal ablation in hypertrophic obstructive cardiomyopathy improves systolic myocardial function in the lateral (free) wall: a follow-up study using CMR tissue tagging and 3D strain analysis. Eur Heart J 27:2833–2839

    Article  PubMed  Google Scholar 

  29. Valeti US, Nishimura RA, Holmes DR, Araoz PA, Glockner JF, Breen JF, Ommen SR, Gersh BJ, Tajik AJ, Rihal CS, Schaff HV, Maron BJ (2007) Comparison of surgical septal myectomy and alcohol septal ablation with cardiac magnetic resonance imaging in patients with hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol 49:350–357

    Article  PubMed  Google Scholar 

  30. Veselka J, Honek T (2003) Early remodeling of left ventricle and improvement of myocardial performance in patients after percutaneous transluminal septal ablation for hypertrophic obstructive cardiomyopathy. Int J Cardiol 88:27–32

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Mrs. Agnieszka Wasniowska and Mrs. Joanna Wasowska for their excellent technical assistance.

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Authors and Affiliations

  1. 1st Department of Coronary Artery Disease and 2nd Catheterization Laboratory, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland

    Mariusz Klopotowski, Lidia Chojnowska, Lukasz A. Malek, Renata Maczynska, Krzysztof Kukula, Marcin Demkow, Adam Witkowski, Maciej Dabrowski, Maciej Karcz, Mariusz Kruk & Witold Ruzyllo

  2. Department of Cardiac Rehabilitation and Noninvasive Electrocardiology, Institute of Cardiology, 04-628, Warsaw, Poland

    Rafal Baranowski

  3. Department of Congenital Heart Disease and Echocardiographic Laboratory, Institute of Cardiology, 04-628, Warsaw, Poland

    Beata Kusmierczyk-Droszcz

  4. Department of Public Health, Medical University of Bialystok, Bialystok, Poland

    Jacek Jamiolkowski

  5. 2nd Department of Cardiac Surgery and Heart Transplantation, Institute of Cardiology, 04-628, Warsaw, Poland

    Mariusz Kusmierczyk

  6. Department of Cardiac Electrophysiology, Institute of Cardiology, 04-628, Warsaw, Poland

    Lukasz Szumowski

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  1. Mariusz Klopotowski
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  2. Lidia Chojnowska
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Correspondence to Mariusz Klopotowski.

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Klopotowski, M., Chojnowska, L., Malek, L.A. et al. The risk of non-sustained ventricular tachycardia after percutaneous alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy. Clin Res Cardiol 99, 285–292 (2010). https://doi.org/10.1007/s00392-010-0116-z

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  • DOI: https://doi.org/10.1007/s00392-010-0116-z

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