title: Intracoronary electrocardiogram during alcohol septal ablation for hypertrophic obstructive cardiomyopathy predicts myocardial injury size.
abstract: Alcohol septal ablation (ASA) has been used widely to treat patients with hypertrophic obstructive cardiomyopathy (HOCM). During the routine ASA procedure, it is difficult to detect the septal injury in real-time. The aim of the present study is to assess myocardial injury during ASA by recording intracoronary electrocardiogram (IC-ECG). From 2012 to 2015, 31 HOCM patients were treated with ASA, and IC-ECG was recorded in 21 patients successfully before and after ethanol injection. The elevation of ST-segment on IC-ECG after ethanol injection was expressed as its ratio to the level before injection or the absolute increasing value. Blood samples were collected before and after ASA for measuring changes in cardiac biomarkers. The ratio value of ST-segment elevation was positively correlated with both the amount of ethanol injected (r = 0.645, P = 0.001) and the myocardial injury size (creatine kinase-MB area under the curve (AUC) of CK-MB) (r = 0.466, P = 0.017). The absolute increment of ST-segment was also positively associated with both the amount of ethanol (r = 0.665, P = 0.001) and AUC of CK-MB (0.685, P = 0.001). However, there was no statistical correlation between the reduction of left ventricular outflow tract gradient and ST-segment elevation. Additionally no severe ASA procedure-related complications were observed in our patients. In conclusion, myocardial injury induced by ethanol injection can be assessed immediately by ST-segment elevation on IC-ECG. This study is the first to show that IC-ECG is a useful method for predicting myocardial injury during ASA in real-time.
authors.affiliation: Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Meng
authors.affiliation: Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Xiaolong
authors.initials: X
authors.lastname: Qu
authors.affiliation: Department of Ultrasonography, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Haiyun
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Shanwen
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Weibo
authors.initials: W
authors.lastname: Zhao
authors.affiliation: Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Guoxiang
authors.initials: G
authors.lastname: He
authors.affiliation: Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Song
authors.affiliation: Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Houyuan
authors.initials: H
authors.lastname: Hu
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects*; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis / Q000628:therapy*; D004562:Electrocardiography; D000431:Ethanol / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006346:Heart Septum / Q000293:injuries*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D000431:Ethanol
keywords: alcohol septal ablation; hypertrophic obstructive cardiomyopathy; intracoronary electrocardiogram