title: Acute decompensation of hypertrophic obstructive cardiomyopathy secondary to A-V disassociation: successful treatment with a combination of alcohol septal ablation and permanent pacemaker.
abstract: Alcohol septal ablation is increasingly being offered as a therapy for patients with hypertrophic obstructive cardiomyopathy. The procedure is most often performed in stable patients with a history of increasing symptoms. We describe a patient with hypertrophic obstructive cardiomyopathy with an acute decompensation secondary to the development of complete heart block. The patient's hemodynamics demonstrates the importance of atrial-ventricular (A-V) synchrony in this disease process. This case report is also a unique description of alcohol septal ablation being performed emergently to improve hemodynamics and the urgent implantation of a permanent pacemaker to return A-V synchrony.
authors.affiliation: Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Rohatgi
authors.forename: Susan E
authors.initials: SE
authors.lastname: Wiegers
authors.forename: Henry
authors.initials: H
authors.lastname: Hsia
authors.forename: Irving
authors.initials: I
authors.lastname: Herling
authors.forename: Howard C
authors.initials: HC
authors.lastname: Herrmann
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy; D004452:Echocardiography; D004562:Electrocardiography; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D006327:Heart Block / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000628:therapy; D010138:Pacemaker, Artificial
chemical_list: D000891:Anti-Infective Agents, Local; D000431:Ethanol