Cuoco Frank A, Spencer William H, Fernandes Valerian L, Nielsen Christopher D, Nagueh Sherif, Sturdivant J Lacy, Leman Robert B, Wharton J Marcus, Gold Michael R
Medical University of South Carolina, Charleston, South Carolina 29425, USA.
J Am Coll Cardiol. 2008 Nov 18;52(21):1718-23. doi: 10.1016/j.jacc.2008.07.061.
The purpose of this study was to examine the effects of alcohol septal ablation (ASA) on ventricular arrhythmias among patients with obstructive hypertrophic cardiomyopathy (HCM), as measured by appropriate implantable cardioverter-defibrillator (ICD) discharges.
Alcohol septal ablation is an effective therapy for patients with symptomatic HCM. However, concern has been raised that ASA may be proarrhythmic secondary to the iatrogenic scar created during the procedure. The impact of ASA on ventricular arrhythmias has not been well described.
This prospective study included 123 consecutive patients with obstructive HCM who underwent ASA and had an ICD implanted for primary prevention of sudden cardiac death (SCD). The ICDs were implanted based on commonly accepted risk factors for SCD in the HCM population. Data from ICD interrogations during routine follow-up were collected.
Nine appropriate ICD shocks were recorded over a mean follow-up of 2.9 years in the cohort, which had a mean of 1.5 +/- 0.9 risk factors for SCD. Using Kaplan-Meier survival analysis, the estimated annual event rate was 2.8% over 3-year follow-up. There were no significant differences in the incidence of risk factors between patients who did and did not receive appropriate shocks.
The annual rate of appropriate ICD discharges after ASA is low and less than that reported previously for primary prevention of SCD in HCM. This suggests that ASA is not proarrhythmic. Traditional SCD risk factors did not predict ICD shocks in this cohort.
本研究旨在通过合适的植入式心脏复律除颤器（ICD）放电情况，探讨酒精间隔消融术（ASA）对梗阻性肥厚型心肌病（HCM）患者室性心律失常的影响。
酒精间隔消融术是有症状的HCM患者的有效治疗方法。然而，有人担心ASA可能因手术过程中形成的医源性瘢痕而导致心律失常。ASA对室性心律失常的影响尚未得到充分描述。
这项前瞻性研究纳入了123例连续接受ASA且植入ICD用于心脏性猝死（SCD）一级预防的梗阻性HCM患者。根据HCM人群中公认的SCD危险因素植入ICD。收集常规随访期间ICD问询的数据。
该队列平均随访2.9年，记录到9次合适的ICD电击，平均有1.5±0.9个SCD危险因素。使用Kaplan-Meier生存分析，3年随访期间估计的年事件发生率为2.8%。接受和未接受合适电击的患者之间危险因素的发生率没有显著差异。
ASA后合适的ICD放电年发生率较低，低于先前报道的HCM患者SCD一级预防的发生率。这表明ASA不会导致心律失常。传统的SCD危险因素在该队列中不能预测ICD电击。
