Division of Cardiology, University of Rochester Medical Center, Rochester, New York.
Division of Cardiology, University of Rochester Medical Center, Rochester, New York; Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York.
Heart Rhythm. 2021 Jan;18(1):50-56. doi: 10.1016/j.hrthm.2020.08.013. Epub 2020 Aug 25.
Alcohol septal ablation (ASA) in patients with hypertrophic cardiomyopathy (HCM) can lead to heart rhythm disturbances including complete heart block (CHB) and atrial and ventricular arrhythmias.
We aimed to evaluate the utility of long-term arrhythmia monitoring with an implantable cardiac monitor (ICM) after ASA.
Between February 2014 and March 2019, 56 patients with HCM undergoing ASA were enrolled in a prospective study and underwent ICM implantation. Kaplan-Meier survival analysis was used to assess the rate of ICM-detected arrhythmic events.
The mean age was 59 ± 11 years, and 20 (36%) were women. The median (25th, 75th percentile) resting left ventricular outflow tract gradient obtained by echocardiography was 43 (22, 81) mm Hg. Greater than 1 septal perforating artery was injected in 48 patients (86%). The Kaplan-Meier cumulative rate of ICM-detected arrhythmic events at 18 months of follow-up was 71%, with an event rate of 43% occurring within 3 months of ASA. The cumulative rate of the ICM-detected first atrial fibrillation event at 18 months was 37%, and the corresponding rate of CHB was 19%. All atrial fibrillation and CHB events were actionable, leading to the initiation of anticoagulation and pacemaker implantation, respectively. No baseline demographic or procedural variables were identified as independent predictors of an increased risk of developing ICM-detected arrhythmic events.
After ASA, ICM is effective in capturing clinically actionable arrhythmic events in patients with HCM regardless of patient's baseline risk factors.
酒精性室间隔消融术（ASA）在肥厚型心肌病（HCM）患者中可导致心律失常，包括完全性心脏阻滞（CHB）和房性及室性心律失常。
我们旨在评估植入式心脏监测仪（ICM）长期监测 ASA 后心律失常的效果。
2014 年 2 月至 2019 年 3 月，56 例行 ASA 的 HCM 患者前瞻性入组本研究，并植入 ICM。Kaplan-Meier 生存分析用于评估 ICM 检测到的心律失常事件的发生率。
患者平均年龄为 59±11 岁，20 例（36%）为女性。超声心动图检测的静息左室流出道梯度中位数（25%，75%分位数）为 43（22，81）mmHg。48 例（86%）患者的间隔穿通支大于 1 支。18 个月随访时，ICM 检测到心律失常事件的 Kaplan-Meier 累积发生率为 71%，其中 43%的事件发生在 ASA 后 3 个月内。18 个月时 ICM 检测到首次心房颤动事件的累积发生率为 37%，相应的 CHB 发生率为 19%。所有心房颤动和 CHB 事件均可行动，分别导致抗凝和起搏器植入的启动。未发现基线人口统计学或手术变量是 ICM 检测到心律失常事件风险增加的独立预测因素。
ASA 后，ICM 可有效捕获 HCM 患者的临床可干预性心律失常事件，无论患者的基线风险因素如何。
