title: Delayed occurrence of unheralded phase IV complete heart block after ethanol septal ablation for symmetric hypertrophic obstructive cardiomyopathy.
abstract: Ethanol septal ablation has emerged as a less invasive alternative to surgical myomectomy for treatment of asymmetric hypertrophic obstructive cardiomyopathy (ASH). The procedure has very low mortality, but high-degree AV conduction block is a frequent complication. Prior studies have documented baseline left bundle branch block and high volume of ethanol injection (greater than 4 mL) as risk factors. Complete heart block is often preceded by postprocedure conduction abnormalities and generally develops within 48 hours after ethanol ablation. We present a unique case of a patient with symmetric hypertensive hypertrophic obstructive cardiomyopathy (SHOCM) who developed phase IV complete heart block >96 hours postprocedure without preceding conduction abnormalities or other classic risk factors.
authors.affiliation: Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: Joanna J
authors.initials: JJ
authors.lastname: Wykrzykowska
authors.forename: Kevin
authors.initials: K
authors.lastname: Kwaku
authors.forename: John
authors.initials: J
authors.lastname: Wylie
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Manning
authors.forename: Mark E
authors.initials: ME
authors.lastname: Josephson
authors.forename: Peter
authors.initials: P
authors.lastname: Zimetbaum
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Laham
mesh_terms: D002312:Cardiomyopathy, Hypertrophic / Q000188:drug therapy*; D004562:Electrocardiography; D000431:Ethanol / Q000008:administration & dosage*; D006327:Heart Block / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D000431:Ethanol