Outcomes of Patients With Hypertrophic Obstructive Cardiomyopathy and Pacemaker Implanted After Alcohol Septal Ablation |
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Affiliation: | 1. Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic;2. Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, the Netherlands;3. Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom;4. Ruhr-University Bochum, Bochum, Germany;5. Cardiocentre Podlesi, Trinec, Czech Republic;6. Department of Endovascular Therapy, Sverdlovsk Regional Hospital No. 1 and Ural Federal University, Yekaterinburg, Russian Federation;7. Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czech Republic;8. Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark;9. Comprehensive Heart Failure Centre, University Clinic Wurzburg, Wurzburg, Germany;10. Department of Cardiology, City Hospital No. 2, Saint-Petersburg, Russian Federation |
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Abstract: | BackgroundAtrioventricular block is a frequent major complication after alcohol septal ablation (ASA).ObjectivesThe aim of this study was to evaluate the outcomes of patients with implanted permanent pacemaker (PPM) related to a high-grade atrioventricular block after ASA for hypertrophic obstructive cardiomyopathy.MethodsWe used a multinational registry (the Euro-ASA registry) to evaluate the outcome of patients with PPM after ASA.ResultsA total of 1,814 patients were enrolled and followed up for 5.0 ± 4.3 years (median = 4.0 years). A total of 170 (9.4%) patients underwent PPM implantation during the first 30 days after ASA. Using propensity score matching, 139 pairs (n = 278) constituted the matched PPM and non-PPM groups. Between the matched groups, there were no long-term differences in New York Heart Association functional class (1.5 ± 0.7 vs 1.5 ± 0.9, P = 0.99) and survival (log-rank P = 0.47). Patients in the matched PPM group had lower long-term left ventricular (LV) outflow gradient (12 ± 12 mm Hg vs 17 ± 19 mm Hg, P < 0.01), more pronounced LV outflow gradient decrease (81% ± 17% vs 72% ± 35%, P < 0.01), and lower LV ejection fraction (64% ± 8% vs 66% ± 8%, P = 0.02) and were less likely to undergo reintervention (re-ASA or myectomy) (log-rank P = 0.02).ConclusionsPatients with hypertrophic obstructive cardiomyopathy treated with ASA have a 9% probability of PPM implantation within 30 days after ASA. In long-term follow-up, patients with PPM had similar long-term survival and New York Heart Association functional class but lower LV outflow gradient, a more pronounced LV outflow gradient decrease, a lower LV ejection fraction, and a lower likelihood of reintervention compared with patients without PPM. |
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Keywords: | alcohol septal ablation permanent pacemaker prognosis ASA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0030" }," $$" :[{" #name" :" text" ," _" :" alcohol septal ablation AV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" atrioventricular BBB" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" bundle branch block CCS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" Canadian Cardiovascular Society HOCM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" hypertrophic obstructive cardiomyopathy ICD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" implantable cardioverter-defibrillator LV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" left ventricular NYHA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" New York Heart Association PPM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" permanent pacemaker |
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