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


OBJECTIVE
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.


CONCLUSIONS
Alcohol septal ablation affected neither the percentage of Holter recordings with nsVT nor the number of nsVT episodes per Holter recording among HOCM patients.
1st Department of Coronary Artery Disease and 2nd Catheterization Laboratory, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland. mklopotowski@hotmail.com
Mariusz
M
Klopotowski
Lidia
L
Chojnowska
Lukasz A
LA
Malek
Renata
R
Maczynska
Krzysztof
K
Kukula
Marcin
M
Demkow
Adam
A
Witkowski
Maciej
M
Dabrowski
Maciej
M
Karcz
Rafal
R
Baranowski
Beata
B
Kusmierczyk-Droszcz
Mariusz
M
Kruk
Jacek
J
Jamiolkowski
Mariusz
M
Kusmierczyk
Lukasz
L
Szumowski
Witold
W
Ruzyllo
D000287:Administration, Topical; D002312:Cardiomyopathy, Hypertrophic / Q000628:therapy*; D004562:Electrocardiography / Q000187:drug effects*; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006346:Heart Septum / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012597:Sclerosing Solutions / Q000008:administration & dosage; D015911:Sclerotherapy / Q000379:methods*; D017180:Tachycardia, Ventricular / Q000139:chemically induced* / Q000175:diagnosis; D016896:Treatment Outcome
D012597:Sclerosing Solutions; D000431:Ethanol