Outcomes of Patients With Hypertrophic Obstructive Cardiomyopathy and Pacemaker Implanted After Alcohol Septal Ablation

• Published in: JACC. Cardiovascular interventions Vol. 15; no. 19; pp. 1910 - 1917
• Main Authors: Veselka, Josef, Liebregts, Max, Cooper, Robert, Faber, Lothar, Januska, Jaroslav, Kashtanov, Maksim, Tesarkova, Klara Hulikova, Hansen, Peter Riis, Seggewiss, Hubert, Shloydo, Eugene, Popov, Kirill, Hansvenclova, Eva, Bonaventura, Jiri, Berg, Jurriën ten, Stables, Rodney Hilton, Polakova, Eva
• Format: Journal Article
• Language: English
• Published: 10.10.2022
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2022.06.034

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.