Vector electrocardiographic alterations after percutaneous septal ablation in obstructive hypertrophic cardiomyopathy. Possible anatomic causes.
OBJECTIVE
Analyze the dromotropic disturbances (vector-electrocardiographic), and the possible anatomic causes, provoked by selective alcohol injection in the septal branch, for percutaneous treatment, of obstructive hypertrophic cardiomyopathy.


METHODS
Ten patients with a mean age of 52.7 years underwent percutaneous septal ablation (PTSA) from october 1998; all in functional class III/IV). Twelve-lead electrocardiogram was performed prior to and during PTSA, and later electrocardiogram and vectorcardiogram according to Frank's method. The patients were followed up for 32 months.


RESULTS
On electrocardiogram (ECG) prior to PTSA all patients had sinus rhythm and left atrial enlargement, 8 left ventricular hypertrophy of systolic pattern. On ECG immediately after PTSA, 8 had complete right bundle-branch block; 1 transient total atrioventricular block; 1 alternating transient bundle-branch block either right or hemiblock. On late ECG 8 had complete right bundle-branch block confirmed by vectorcardiogram, type 1 or Grishman.


CONCLUSIONS
Septal fibrosis following alcohol injection caused a predominance of complete right bundle-branch block, different from surgery of myotomy/myectomy.
Riera
Andrés Ricardo Pérez
AR
Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil. sicano@terra.com.br
de Cano
Silvia Judith Fortunato
SJ
Cano
Manuel Nicolás
MN
Gimenez
Vera Márcia L
VM
de Padua Fleury Neto
Luciano Augusto
LA
Sousa
José Eduardo M R
JE
D000328:Adult; D000368:Aged; D002037:Bundle-Branch Block / Q000139:chemically induced* / Q000503:physiopathology; D002312:Cardiomyopathy, Hypertrophic / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D005355:Fibrosis; D006346:Heart Septum / Q000187:drug effects* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D014672:Vectorcardiography
D000431:Ethanol