Ventricular Arrhythmia Following Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy

      We sought to assess the risk of sudden cardiac death (SCD) and ventricular arrhythmia after alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy. ASA is a nonsurgical alternative to septal myectomy for treatment of symptomatic, drug-refractory, obstructive hypertrophic cardiomyopathy. The effect of ASA on ventricular arrhythmia risk is not well established. We examined the rates of SCD among 89 patients treated with ASA. The secondary end point was ventricular tachycardia/ventricular fibrillation (VT/VF), appropriate implantable cardioverter defibrillator (ICD) therapy, or cardiac arrest after ASA among those with implanted ICDs or permanent pacemakers (n = 42). Patients were classified as either high-risk or low-risk on the basis of established clinical indications for ICD implantation. No mortality was attributable to SCD at a mean follow-up of 5.0 ± 2.3 years in the entire cohort. Among the 42 patients with an ICD or permanent pacemaker, 9 had documented VT/VF, cardiac arrest, or appropriate ICD therapy, resulting in an annual event rate of 4.9%/year. The annual event rate for VT/VF, cardiac arrest, or appropriate ICD therapy was 2.8%/year (4 of 29 patients) in low-risk patients and 13.4% in high-risk patients (5 of 13 patients). A 10-mm Hg increase in the immediate post-ASA gradient was associated with a hazard ratio of 2.66 for arrhythmic events (95% confidence interval 1.55 to 4.56, p <0.001). In conclusion, ASA was performed in patients with highly symptomatic, drug-refractory hypertrophic cardiomyopathy with no mortality attributable to SCD and an annual rate of VT/VF, cardiac arrest, or appropriate ICD therapy of 4.9%/year.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Spirito P.
        • Bellone P.
        • Harris K.M.
        • Bernabo P.
        • Bruzzi P.
        • Maron B.J.
        Magnitude of left ventricular hypertrophy and risk of sudden death in hypertrophic cardiomyopathy.
        N Engl J Med. 2000; 342: 1778-1785
        • Cuoco F.A.
        • Spencer III, W.H.
        • Fernandes V.L.
        • Nielsen C.D.
        • Nagueh S.
        • Sturdivant J.L.
        • Leman R.B.
        • Wharton J.M.
        • Gold M.R.
        Implantable cardioverter-defibrillator therapy for primary prevention of sudden death after alcohol septal ablation of hypertrophic cardiomyopathy.
        J Am Coll Cardiol. 2008; 52: 1718-1723
        • Maron B.J.
        • Spirito P.
        • Shen W.K.
        • Haas T.S.
        • Formisano F.
        • Link M.S.
        • Epstein A.E.
        • Almquist A.K.
        • Daubert J.P.
        • Lawrenz T.
        • Boriani G.
        • Estes III, N.A.
        • Favale S.
        • Piccininno M.
        • Winters S.L.
        • Santini M.
        • Betocchi S.
        • Arribas F.
        • Sherrid M.V.
        • Buja G.
        • Semsarian C.
        • Bruzzi P.
        Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy.
        JAMA. 2007; 298: 405-412
        • Boltwood Jr, C.M.
        • Chien W.
        • Ports T.
        Ventricular tachycardia complicating alcohol septal ablation.
        N Engl J Med. 2004; 351: 1914-1915
        • Hori Y.
        • Ueda M.
        • Nakayama T.
        • Saegusa N.
        • Uehara M.
        • Lee K.
        • Sekine T.
        • Daimon M.
        • Kobayashi Y.
        • Funabashi N.
        • Komuro I.
        Occurrence of de novo sustained monomorphic ventricular tachycardia induced after percutaneous transluminal alcohol septal myocardial ablation for hypertrophic obstructive cardiomyopathy.
        Int J Cardiol. 2007; 119: 403-407
        • McGregor J.B.
        • Rahman A.
        • Rosanio S.
        • Ware D.
        • Birnbaum Y.
        • Saeed M.
        Monomorphic ventricular tachycardia: a late complication of percutaneous alcohol septal ablation for hypertrophic cardiomyopathy.
        Am J Med Sci. 2004; 328: 185-188
        • Simon R.D.
        • Crawford III, F.A.
        • Spencer III, W.H.
        • Gold M.R.
        Sustained ventricular tachycardia following alcohol septal ablation for hypertrophic obstructive cardiomyopathy.
        Pacing Clin Electrophysiol. 2005; 28: 1354-1356
        • Lawrenz T.
        • Obergassel L.
        • Lieder F.
        • Leuner C.
        • Strunk-Mueller C.
        • Meyer Zu Vilsendorf D.
        • Beer G.
        • Kuhn H.
        Transcoronary ablation of septal hypertrophy does not alter ICD intervention rates in high risk patients with hypertrophic obstructive cardiomyopathy.
        Pacing Clin Electrophysiol. 2005; 28: 295-300
        • Guo H.
        • Wang P.
        • Xing Y.
        • Peng F.
        • Jiang J.
        • Yang B.
        • You B.
        • Qiu Y.
        • Lee J.D.
        Delayed electrocardiographic changes after percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy.
        J Electrocardiol. 2007; 40: e1-e6
        • Kuhn H.
        • Lawrenz T.
        • Lieder F.
        • Leuner C.
        • Strunk-Mueller C.
        • Obergassel L.
        • Bartelsmeier M.
        • Stellbrink C.
        Survival after transcoronary ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy (TASH): a 10 year experience.
        Clin Res Cardiol. 2008; 97: 234-243
        • Chen A.A.
        • Palacios I.F.
        • Mela T.
        • Yoerger D.M.
        • Picard M.H.
        • Vlahakes G.
        • Lowry P.A.
        • Fifer M.A.
        Acute predictors of subacute complete heart block after alcohol septal ablation for obstructive hypertrophic cardiomyopathy.
        Am J Cardiol. 2006; 97: 264-269
        • Baggish A.L.
        • Smith R.N.
        • Palacios I.
        • Vlahakes G.J.
        • Yoerger D.M.
        • Picard M.H.
        • Lowry P.A.
        • Jang I.K.
        • Fifer M.A.
        Pathological effects of alcohol septal ablation for hypertrophic obstructive cardiomyopathy.
        Heart. 2006; 92: 1773-1778
        • Ellenbogen K.A.
        • Levine J.H.
        • Berger R.D.
        • Daubert J.P.
        • Winters S.L.
        • Greenstein E.
        • Shalaby A.
        • Schaechter A.
        • Subacius H.
        • Kadish A.
        Are implantable cardioverter defibrillator shocks a surrogate for sudden cardiac death in patients with nonischemic cardiomyopathy?.
        Circulation. 2006; 113: 776-782
        • Maron M.S.
        • Olivotto I.
        • Betocchi S.
        • Casey S.A.
        • Lesser J.R.
        • Losi M.A.
        • Cecchi F.
        • Maron B.J.
        Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy.
        N Engl J Med. 2003; 348: 295-303
        • Ommen S.R.
        • Maron B.J.
        • Olivotto I.
        • Maron M.S.
        • Cecchi F.
        • Betocchi S.
        • Gersh B.J.
        • Ackerman M.J.
        • McCully R.B.
        • Dearani J.A.
        • Schaff H.V.
        • Danielson G.K.
        • Tajik A.J.
        • Nishimura R.A.
        Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy.
        J Am Coll Cardiol. 2005; 46: 470-476
        • Elliott P.M.
        • Gimeno J.R.
        • Tome M.T.
        • Shah J.
        • Ward D.
        • Thaman R.
        • Mogensen J.
        • McKenna W.J.
        Left ventricular outflow tract obstruction and sudden death risk in patients with hypertrophic cardiomyopathy.
        Eur Heart J. 2006; 27: 1933-1941