Complications of low-dose, echo-guided alcohol septal ablation.
BACKGROUND
Alcohol septal ablation (ASA) is a catheter-based intervention that has been used as an alternative to surgical myectomy in highly symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM).


METHODS
This retrospective study was designed to evaluate the incidence of major complications in the mid-term follow-up of low-dose (1-2.5 ml of ethanol), echo-guided alcohol septal ablation.


RESULTS
A total of 101 consecutive patients (56 +/- 15 years) with highly symptomatic HOCM were enrolled. At 6 months, there was a significant decrease in resting outflow gradient accompanied by reduction in basal septal diameter and improvement in symptoms (P < 0.01). Two patients (2%) experienced procedural ventricular tachycardias terminated by electrical cardioversion. A total of 87 patients (86%) underwent an uneventful postprocedural hospital stay. The postprocedural complete heart block occurred in 10 patients (10%), and subsequent permanent pacemaker was implanted in four cases (4%). Sustained ventricular arrhythmias requiring electrical cardioversion occurred in four patients (4%) within postprocedural hospital stay. Subsequently, ICD was not implanted in any of these cases. The patients were repeatedly examined by Holter ECG monitoring, and in the mid-term follow-up (6-50 months), they stayed asymptomatic and without any ventricular arrhythmias.


CONCLUSIONS
This study demonstrates the same early incidence of complete heart block requiring permanent pacemaker implantation (4%) and sustained ventricular arrhythmias following low-dose, echo-guided ASA.
Veselka
Josef
J
CardioVascular Center, University Hospital Motol, Prague, Czech Republic. veselka.josef@seznam.cz
Zemánek
David
D
Tomasov
Pavol
P
Homolová
Stanislava
S
Adlová
Radka
R
Tesar
David
D
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002304:Cardiac Pacing, Artificial; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D004554:Electric Countershock; D015716:Electrocardiography, Ambulatory; D000431:Ethanol / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006327:Heart Block / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D000431:Ethanol