Schuller Joseph L, Zipse Matthew M, Krantz Mori J, Blaker Brian, Salcedo Ernesto, Groves Bertron M, Messenger John C, Beaty Brenda, Sauer William H
Cardiology Division, Denver Health, Denver, Colorado; University of Colorado School of Medicine, Aurora, Colorado.
J Interv Cardiol. 2015 Feb;28(1):90-7. doi: 10.1111/joic.12178.
This study was designed to identify the incidence of late complete heart block (CHB) first identified at least 48 hours post alcohol septal ablation (ASA).
Septal reduction with ASA is a therapeutic option for patients with symptomatic hypertrophic obstructive cardiomyopathy (HCM). CHB, resulting from the septal infarct, is a known complication with a reported incidence of 9-22%. The incidence of CHB more than 48 hours post-procedure is unknown.
Consecutive patients who underwent ASA were analyzed and clinical characteristics associated with late CHB were assessed. Late CHB was defined as first identification of CHB more than 48 hours after ASA.
From 2002-2013, 145 subjects underwent 168 ASA procedures and were followed for a mean of 3.2 +/- 2.3 years. The incidence of late CHB was 8.9% (15/168 ASA procedures). Heart block occurred from 48 hours to 3-years post-procedure. In a multivariable model, patients with any CHB were more likely to have had multiple ASA procedures (OR 4.14; 95% CI: 1.24, 13.9; P < 0.05) and high resting and provoked left ventricular outflow tract (LVOT) gradient assessed by catheterization (OR per 10 mmHg gradient 1.14; 95% CI: 1.0, 1.20; P < 0.05). After multivariable adjustment, only a high provokable LVOT gradient remained an independent predictor of late CHB (OR per 10 mmHg gradient 1.14 [95% CI 1.02-1.29]).
Late CHB is a common complication of ASA for treatment of symptomatic HCM. Post-discharge electrocardiographic surveillance for atrioventricular conduction disease should be considered after ASA, especially for those with a high provokable LVOT gradient.
本研究旨在确定酒精室间隔消融术（ASA）后至少48小时首次发现的晚期完全性心脏传导阻滞（CHB）的发生率。
ASA进行间隔消融是有症状的肥厚性梗阻性心肌病（HCM）患者的一种治疗选择。由间隔梗死导致的CHB是一种已知并发症，报道的发生率为9%-22%。术后48小时以上发生CHB的发生率尚不清楚。
对连续接受ASA的患者进行分析，并评估与晚期CHB相关的临床特征。晚期CHB定义为ASA后48小时以上首次发现CHB。
2002年至2013年，145名受试者接受了168次ASA手术，平均随访3.2±2.3年。晚期CHB的发生率为8.9%（168次ASA手术中有15例）。心脏传导阻滞发生在术后48小时至3年。在多变量模型中，发生任何CHB的患者更可能接受多次ASA手术（比值比4.14；95%置信区间：1.24，13.9；P<0.05），并且通过导管检查评估的静息和激发状态下左心室流出道（LVOT）梯度较高（每10mmHg梯度的比值比1.14；95%置信区间：1.0，1.20；P<0.05）。多变量调整后，只有激发状态下较高的LVOT梯度仍然是晚期CHB的独立预测因素（每10mmHg梯度的比值比1.14[95%置信区间1.02-1.29]）。
晚期CHB是ASA治疗有症状HCM的常见并发症。ASA术后应考虑对房室传导疾病进行出院后心电图监测，尤其是对于激发状态下LVOT梯度较高的患者。
