Lawrenz Thorsten, Obergassel Ludger, Lieder Frank, Leuner Christian, Strunk-Mueller Claudia, Meyer Zu Vilsendorf Dorothee, Beer Gerald, Kuhn Horst
Department of Cardiology and Internal Intensive Care, Bielefeld Klinikum, Academic Teaching Hospital of the University of Muenster, Teutoburger Strasse 50, D-33604 Bielefeld, Germany.
Pacing Clin Electrophysiol. 2005 Apr;28(4):295-300. doi: 10.1111/j.1540-8159.2005.09327.x.
Transcoronary ablation of septal hypertrophy (TASH) is safe and effectively reduces the intraventricular gradient in patients with hypertrophic obstructive cardiomyopathy (HOCM). To analyze the potential of anti- and proarrhythmic effects of TASH, we studied the discharge rates of implanted cardioverter defibrillators (ICD) in patients with HOCM who are at a high risk for sudden cardiac death.
ICD and TASH were performed in 15 patients. Indications for ICD-implantation were secondary prevention in nine patients after resuscitation from cardiac arrest with documented ventricular fibrillation (n = 7) or sustained ventricular tachycardia (n = 2) and primary prevention in 6 patients with a family history of sudden deaths, nonsustained ventricular tachycardia, and/or syncope. All the patients had severe symptoms due to HOCM (NYHA functional class = 2.9).
During a mean follow-up time of 41 +/- 22.7 months following the TASH procedure, 4 patients had episodes of appropriate discharges (8% per year). The discharge rate in the secondary prevention group was 10% per year and 5% in the group with primary prophylactic implants. Three patients died during follow-up (one each of pulmonary embolism, stroke, and sudden death).
In conclusion, on the basis of ICD-discharge rates in HOCM-patients at high risk for sudden death, there is no evidence for an unfavorable arrhythmogenic effect of TASH. The efficacy of ICD treatment for the prevention of sudden cardiac death in HOCM could be confirmed, however, mortality is high in this cohort of hypertrophic cardiomyopathy patients.
经冠状动脉间隔肥厚消融术（TASH）安全有效，可降低肥厚性梗阻性心肌病（HOCM）患者的心室梯度。为分析TASH抗心律失常和促心律失常作用的可能性，我们研究了HOCM患者植入式心脏复律除颤器（ICD）的放电率，这些患者有心脏性猝死的高风险。
对15例患者进行了ICD植入和TASH手术。ICD植入的指征包括：9例患者为心脏骤停复苏后伴有记录在案的室颤（n = 7）或持续性室性心动过速（n = 2）的二级预防，6例患者有猝死家族史、非持续性室性心动过速和/或晕厥为一级预防。所有患者均因HOCM出现严重症状（纽约心脏协会功能分级 = 2.9）。
在TASH手术后平均41±22.7个月的随访期内，4例患者出现了适当的放电（每年8%）。二级预防组的放电率为每年10%，一级预防性植入组为5%。3例患者在随访期间死亡（分别死于肺栓塞、中风和猝死各1例）。
总之，基于HOCM猝死高风险患者的ICD放电率，没有证据表明TASH有致心律失常的不良作用。然而，ICD治疗预防HOCM患者心脏性猝死的疗效可以得到证实，不过在这一肥厚型心肌病患者队列中死亡率较高。
