Atrioventricular conduction after alcohol septal ablation for obstructive hypertrophic cardiomyopathy

Anna Axelsson; Kristina Weibring; Ole Havndrup; Henning Kelbæk; Erik Jørgensen; Steffen Helqvist; Kasper Iversen; Lars Køber; Henning Bundgaard; Morten Kvistholm Jensen

doi:10.2459/jcm.0b013e3283638073

Atrioventricular conduction after alcohol septal ablation for obstructive hypertrophic cardiomyopathy

Anna Axelsson, Kristina Weibring, Ole Havndrup, Henning Kelbæk, Erik Jørgensen, Steffen Helqvist, Kasper Iversen, Lars Køber, Henning Bundgaard, Morten Kvistholm Jensen

Department of Clinical Medicine

7 Citations (Scopus)

Abstract

AIMS: Lesion of the atrioventricular conduction system is a well known adverse effect of alcohol septal ablation (ASA) in patients with obstructive hypertrophic cardiomyopathy (HCM). We assessed the atrioventricular conduction at long-term follow-up after ASA.

METHODS: In patients with a pacemaker implanted for high-grade atrioventricular block after ASA, the atrioventricular conduction was assessed prospectively by ECGs and 48-h Holter recordings. In the remaining patients, the atrioventricular conduction was analysed retrospectively for comparison.

RESULTS: A total of 24 (28%) of 87 patients with obstructive HCM without a pacemaker at baseline had a pacemaker implanted due to high-grade atrioventricular block after ASA. Ten of these patients were not available for follow-up. Holter recordings in the remaining 14 patients revealed normalized atrioventricular conduction in 6 patients 6.2 years (range 2.1-9.4) after ASA. Patients with high-grade atrioventricular block at follow-up had longer PR intervals at baseline [205 ms (200-230)] than the rest of the cohort [180 ms (140-200), P = 0.004] and a higher incidence of acute complete heart block (63 vs. 15%; P = 0.007) during ASA. A PR interval of at least 200 ms at baseline was associated with higher prevalence of high-grade atrioventricular block at follow-up (30 vs. 2%; P = 0.0013). The incidence of late-onset complete heart block was 1.5% per year after ASA.

CONCLUSION: We found normalized atrioventricular conduction at long-term follow-up, suggesting recovery in 6 of 14 patients with a pacemaker implanted in relation to ASA. Permanent atrioventricular conduction abnormalities were associated with baseline PR intervals of at least 200 ms and acute persistent complete heart block during ASA.

Original language	English
Journal	Journal of Cardiovascular Medicine (Hagerstown)
Volume	15
Issue number	3
Pages (from-to)	214-221
Number of pages	8
ISSN	1558-2027
DOIs	https://doi.org/10.2459/jcm.0b013e3283638073
Publication status	Published - Mar 2014

Keywords

Ablation Techniques
Aged
Atrioventricular Block
Cardiomyopathy, Hypertrophic
Electrocardiography
Ethanol
Female
Follow-Up Studies
Heart Conduction System
Humans
Male
Middle Aged
Pacemaker, Artificial
Prospective Studies

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10.2459/jcm.0b013e3283638073

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@article{3e426c2787b442f599d87bb92c89b375,

title = "Atrioventricular conduction after alcohol septal ablation for obstructive hypertrophic cardiomyopathy",

abstract = "AIMS: Lesion of the atrioventricular conduction system is a well known adverse effect of alcohol septal ablation (ASA) in patients with obstructive hypertrophic cardiomyopathy (HCM). We assessed the atrioventricular conduction at long-term follow-up after ASA.METHODS: In patients with a pacemaker implanted for high-grade atrioventricular block after ASA, the atrioventricular conduction was assessed prospectively by ECGs and 48-h Holter recordings. In the remaining patients, the atrioventricular conduction was analysed retrospectively for comparison.RESULTS: A total of 24 (28%) of 87 patients with obstructive HCM without a pacemaker at baseline had a pacemaker implanted due to high-grade atrioventricular block after ASA. Ten of these patients were not available for follow-up. Holter recordings in the remaining 14 patients revealed normalized atrioventricular conduction in 6 patients 6.2 years (range 2.1-9.4) after ASA. Patients with high-grade atrioventricular block at follow-up had longer PR intervals at baseline [205 ms (200-230)] than the rest of the cohort [180 ms (140-200), P = 0.004] and a higher incidence of acute complete heart block (63 vs. 15%; P = 0.007) during ASA. A PR interval of at least 200 ms at baseline was associated with higher prevalence of high-grade atrioventricular block at follow-up (30 vs. 2%; P = 0.0013). The incidence of late-onset complete heart block was 1.5% per year after ASA.CONCLUSION: We found normalized atrioventricular conduction at long-term follow-up, suggesting recovery in 6 of 14 patients with a pacemaker implanted in relation to ASA. Permanent atrioventricular conduction abnormalities were associated with baseline PR intervals of at least 200 ms and acute persistent complete heart block during ASA.",

keywords = "Ablation Techniques, Aged, Atrioventricular Block, Cardiomyopathy, Hypertrophic, Electrocardiography, Ethanol, Female, Follow-Up Studies, Heart Conduction System, Humans, Male, Middle Aged, Pacemaker, Artificial, Prospective Studies",

author = "Anna Axelsson and Kristina Weibring and Ole Havndrup and Henning Kelb{\ae}k and Erik J{\o}rgensen and Steffen Helqvist and Kasper Iversen and Lars K{\o}ber and Henning Bundgaard and Jensen, {Morten Kvistholm}",

year = "2014",

month = mar,

doi = "10.2459/jcm.0b013e3283638073",

language = "English",

volume = "15",

pages = "214--221",

journal = "Journal of Cardiovascular Medicine",

issn = "1558-2027",

publisher = "Lippincott Williams & Wilkins",

number = "3",

}

TY - JOUR

T1 - Atrioventricular conduction after alcohol septal ablation for obstructive hypertrophic cardiomyopathy

AU - Axelsson, Anna

AU - Weibring, Kristina

AU - Havndrup, Ole

AU - Kelbæk, Henning

AU - Jørgensen, Erik

AU - Helqvist, Steffen

AU - Iversen, Kasper

AU - Køber, Lars

AU - Bundgaard, Henning

AU - Jensen, Morten Kvistholm

PY - 2014/3

Y1 - 2014/3

N2 - AIMS: Lesion of the atrioventricular conduction system is a well known adverse effect of alcohol septal ablation (ASA) in patients with obstructive hypertrophic cardiomyopathy (HCM). We assessed the atrioventricular conduction at long-term follow-up after ASA.METHODS: In patients with a pacemaker implanted for high-grade atrioventricular block after ASA, the atrioventricular conduction was assessed prospectively by ECGs and 48-h Holter recordings. In the remaining patients, the atrioventricular conduction was analysed retrospectively for comparison.RESULTS: A total of 24 (28%) of 87 patients with obstructive HCM without a pacemaker at baseline had a pacemaker implanted due to high-grade atrioventricular block after ASA. Ten of these patients were not available for follow-up. Holter recordings in the remaining 14 patients revealed normalized atrioventricular conduction in 6 patients 6.2 years (range 2.1-9.4) after ASA. Patients with high-grade atrioventricular block at follow-up had longer PR intervals at baseline [205 ms (200-230)] than the rest of the cohort [180 ms (140-200), P = 0.004] and a higher incidence of acute complete heart block (63 vs. 15%; P = 0.007) during ASA. A PR interval of at least 200 ms at baseline was associated with higher prevalence of high-grade atrioventricular block at follow-up (30 vs. 2%; P = 0.0013). The incidence of late-onset complete heart block was 1.5% per year after ASA.CONCLUSION: We found normalized atrioventricular conduction at long-term follow-up, suggesting recovery in 6 of 14 patients with a pacemaker implanted in relation to ASA. Permanent atrioventricular conduction abnormalities were associated with baseline PR intervals of at least 200 ms and acute persistent complete heart block during ASA.

AB - AIMS: Lesion of the atrioventricular conduction system is a well known adverse effect of alcohol septal ablation (ASA) in patients with obstructive hypertrophic cardiomyopathy (HCM). We assessed the atrioventricular conduction at long-term follow-up after ASA.METHODS: In patients with a pacemaker implanted for high-grade atrioventricular block after ASA, the atrioventricular conduction was assessed prospectively by ECGs and 48-h Holter recordings. In the remaining patients, the atrioventricular conduction was analysed retrospectively for comparison.RESULTS: A total of 24 (28%) of 87 patients with obstructive HCM without a pacemaker at baseline had a pacemaker implanted due to high-grade atrioventricular block after ASA. Ten of these patients were not available for follow-up. Holter recordings in the remaining 14 patients revealed normalized atrioventricular conduction in 6 patients 6.2 years (range 2.1-9.4) after ASA. Patients with high-grade atrioventricular block at follow-up had longer PR intervals at baseline [205 ms (200-230)] than the rest of the cohort [180 ms (140-200), P = 0.004] and a higher incidence of acute complete heart block (63 vs. 15%; P = 0.007) during ASA. A PR interval of at least 200 ms at baseline was associated with higher prevalence of high-grade atrioventricular block at follow-up (30 vs. 2%; P = 0.0013). The incidence of late-onset complete heart block was 1.5% per year after ASA.CONCLUSION: We found normalized atrioventricular conduction at long-term follow-up, suggesting recovery in 6 of 14 patients with a pacemaker implanted in relation to ASA. Permanent atrioventricular conduction abnormalities were associated with baseline PR intervals of at least 200 ms and acute persistent complete heart block during ASA.

KW - Ablation Techniques

KW - Aged

KW - Atrioventricular Block

KW - Cardiomyopathy, Hypertrophic

KW - Electrocardiography

KW - Ethanol

KW - Female

KW - Follow-Up Studies

KW - Heart Conduction System

KW - Humans

KW - Male

KW - Middle Aged

KW - Pacemaker, Artificial

KW - Prospective Studies

U2 - 10.2459/jcm.0b013e3283638073

DO - 10.2459/jcm.0b013e3283638073

M3 - Journal article

C2 - 24662414

SN - 1558-2027

VL - 15

SP - 214

EP - 221

JO - Journal of Cardiovascular Medicine

JF - Journal of Cardiovascular Medicine

IS - 3

ER -

Atrioventricular conduction after alcohol septal ablation for obstructive hypertrophic cardiomyopathy

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Keywords

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