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.
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Article info
Publication history
Published online: May 05, 2009
Accepted:
February 20,
2009
Received in revised form:
February 20,
2009
Received:
January 12,
2009
Footnotes
Dr. Das was funded by a career development grant from American College of Cardiology-Pfizer, Bethesda, Maryland. Dr. Fifer has received a research grant from Merck, Whitehouse Station, NJ (≥$10,000) and private donations (≥$10,000) for research in hypertrophic cardiomyopathy, as well as honoraria for speaking on hypertrophic cardiomyopathy.
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
