Josef Veselka, Max Liebregts, Robert Cooper, Lothar Faber, Jaroslav Januska, Maksim Kashtanov, Klara Hulikova Tesarkova, Peter Riis Hansen, Hubert Seggewiss, Eugene Shloydo, Kirill Popov, Eva Hansvenclova, Jiri Bonaventura, Jurriën Ten Berg, Rodney Hilton Stables, Eva Polakova. JACC: Cardiovascular Interventions. 2022 October 10. doi.org/10.1016/j.jcin.2022.06.034. IF: 11,075
prof. MUDr. Josef Veselka, CSc., Kardiologická klinika 2. LF UK a FN Motol
Abstract
Background
Atrioventricular block is a frequent major complication after alcohol septal ablation (ASA).
Objectives
The 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.
Methods
We used a multinational registry (the Euro-ASA registry) to evaluate the outcome of patients with PPM after ASA.
Results
A 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).
Conclusions
Patients 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.
