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Predictors of cardiovascular implantable electronic device dependence at long-term follow-up after alcohol septal ablation in hypertrophic cardiomyopathy patients

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Abstract

Background

The most common complication of alcohol septal ablation (ASA) is transient periprocedural high-grade AV block (HGAVB). To date, no long-term follow-up of cardiovascular implantable electronic device (CIED) utilization after ASA has been reported. We hypothesized that CIED dependence on long-term follow-up can be predicted by ECG or procedural characteristics.

Methods

We analyzed all patients with HCM who underwent ASA from December 1998 to December 2019 and received their first CIED within 30 days after ASA for HGAVB. All follow-up interrogations were reviewed. CIED dependence was defined as ventricular pacing of ≥ 5%.

Results

A total of 138 patients with HCM underwent ASA. Of these, 35 had a prior device and were excluded. Of the remaining 103 patients, 25 patients received a CIED for HGAVB within 30 days after ASA. Average follow-up duration was 10.1 years. On long-term follow-up, 16 patients (64%) were found to be CIED-dependent. Baseline characteristics, including pre- and post-ASA ECG, were not significantly different between dependent and non-dependent patients. The only predictor for CIED dependence was > 1 ml of alcohol injected (OR 6.0, p = 0.031).

Conclusions

CIED implantation after ASA is common. Almost two thirds of patients who received a CIED for post-procedural HGAVB were CIED-dependent on long-term follow-up. CIED dependence can be predicted by the amount of injected alcohol > 1 ml.

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Data Availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Massachusetts General Hospital.

References

  1. Sorajja P, Valeti U, Nishimura RA, Ommen SR, Rihal CS, Gersh BJ, Hodge DO, Schaff HV, Holmes DR. Outcome of alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Circulation. 2008;118:131–9.

    Article  PubMed  Google Scholar 

  2. Jensen MK, Prinz C, Horstkotte D, van Buuren F, Bitter T, Faber L, Bundgaard H. Alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy: low incidence of sudden cardiac death and reduced risk profile. Heart. 2013;99:1012–7.

    Article  PubMed  Google Scholar 

  3. Lucon A, Palud L, Pavin D, Donal E, Behar N, Leclercq C, Mabo P, Daubert J-C. Very late effects of dual chamber pacing therapy for obstructive hypertrophic cardiomyopathy. Arch Cardiovasc Dis. 2013;106:373–81.

    Article  PubMed  Google Scholar 

  4. Veselka J, Krejčí J, Tomašov P, Zemánek D. Long-term survival after alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a comparison with general population. Eur Heart J. 2014;35:2040–5.

    Article  PubMed  Google Scholar 

  5. Fortunato de Cano S, Nicolas Cano M, de Ribamar Costa J, Alves Pinheiro J, de Mattos Bellio, Barretto R, de Souza Costa, Le Bihan D, Abizaid A, Sousa A, Eduardo Sousa J. Long-term clinical follow-up of patients undergoing percutaneous alcohol septal reduction for symptomatic obstructive hypertrophic cardiomyopathy. Catheter Cardiovasc Interv. 2016;88:953–60.

    Article  PubMed  Google Scholar 

  6. Liebregts M, Steggerda RC, Vriesendorp PA, van Velzen H, Schinkel AFL, Willems R, van Cleemput J, van den Berg MP, Michels M, ten Berg JM. Long-term outcome of alcohol septal ablation for obstructive hypertrophic cardiomyopathy in the young and the elderly. JACC Cardiovasc Interv. 2016;9:463–9.

    Article  PubMed  Google Scholar 

  7. Rigopoulos AG, Seggewiss H. Twenty years of alcohol septal ablation in hypertrophic obstructive cardiomyopathy. Curr Cardiol Rev. 2016;12:285–96.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Liebregts M, Faber L, Jensen MK, Vriesendorp PA, Januska J, Krejci J, Hansen PR, Seggewiss H, Horstkotte D, Adlova R, et al. Outcomes of alcohol septal ablation in younger patients with obstructive hypertrophic cardiomyopathy. JACC Cardiovasc Interv. 2017;10:1134–43.

    Article  PubMed  Google Scholar 

  9. Wojtarowicz A, Kornacewicz-Jach Z. Alcohol septal ablation in hypertrophic cardiomyopathy utilizing a longitudinal 17-year study (mean 10.8) Observation follow-ups taken at a single medical centre. Cardiol J. 2017;24:125–30.

    Article  PubMed  Google Scholar 

  10. Nogic J, Koh Y, Bak M, Gooley RP, Meredith IT, McCormick LM. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a 16-year australian single centre experience. Heart Lung Circ. 2018;27:1446–53.

    Article  PubMed  Google Scholar 

  11. Aguiar Rosa S, Fiarresga A, Galrinho A, Cacela D, Ramos R, de Sousa L, Gonçalves A, Bernardes L, Patrício L, Branco LM, et al. Short- and long-term outcome after alcohol septal ablation in obstructive hypertrophic cardiomyopathy: Experience of a reference center. Rev Port Cardiol. 2019;38:473–80.

    Article  PubMed  Google Scholar 

  12. Fifer MA. Choice of septal reduction therapies and alcohol septal ablation. Cardiol Clin. 2019;37:83–93.

    Article  PubMed  Google Scholar 

  13. Sorajja P, Ommen SR, Holmes DR, Dearani JA, Rihal CS, Gersh BJ, Lennon RJ, Nishimura RA. Survival after alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Circulation. 2012;126:2374–80.

    Article  PubMed  Google Scholar 

  14. Ralph-Edwards A, Woo A, McCrindle BW, Shapero JL, Schwartz L, Rakowski H, Wigle ED, Williams WG. Hypertrophic obstructive cardiomyopathy: comparison of outcomes after myectomy or alcohol ablation adjusted by propensity score. J Thorac Cardiovasc Surg. 2005;129:351–8.

    Article  PubMed  Google Scholar 

  15. Talreja DR, Nishimura RA, Edwards WD, Valeti US, Ommen SR, Tajik AJ, Dearani JA, Schaff HV, Holmes DR. Alcohol septal ablation versus surgical septal myectomy: comparison of effects on atrioventricular conduction tissue. J Am Coll Cardiol. 2004;44:2329–32.

    Article  PubMed  Google Scholar 

  16. Holmes DR, Valeti US, Nishimura RA. Alcohol septal ablation for hypertrophic cardiomyopathy: indications and technique. Catheter Cardiovasc Interv. 2005;66:375–89.

    Article  PubMed  Google Scholar 

  17. Runquist LH, Nielsen CD, Killip D, Gazes P, Spencer WH. Electrocardiographic findings after alcohol septal ablation therapy for obstructive hypertrophic cardiomyopathy. Am J Cardiol. 2002;90:1020–2.

    Article  PubMed  Google Scholar 

  18. El-Jack SS, Nasif M, Blake JW, Dixon SR, Grines CL, O’Neill WW. Predictors of complete heart block after alcohol septal ablation for hypertrophic cardiomyopathy and the timing of pacemaker implantation. J Interv Cardiol. 2007;20:73–6.

    Article  PubMed  Google Scholar 

  19. Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, Naidu SS, Nishimura RA, Ommen SR, Rakowski H, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124:e783-831.

    PubMed  Google Scholar 

  20. Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, et al. 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2020;76:e159–240.

    Article  PubMed  Google Scholar 

  21. Nishimura RA, Holmes DR. Clinical practice Hypertrophic obstructive cardiomyopathy. N Engl J Med. 2004;350:1320–7.

    Article  PubMed  CAS  Google Scholar 

  22. Kern MJ, Holmes DG, Simpson C, Bitar SR, Rajjoub H. Delayed occurrence of complete heart block without warning after alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Catheter Cardiovasc Interv. 2002;56:503–7.

    Article  PubMed  Google Scholar 

  23. Weissler-Snir A, Dorian P, Rakowski H, Care M, Spears D. Primary prevention implantable cardioverter-defibrillators in hypertrophic cardiomyopathy-are there predictors of appropriate therapy? Hear Rhythm. 2021;18:63–70.

    Article  Google Scholar 

  24. Jensen MK, Faber L, Liebregts M, Januska J, Krejci J, Bartel T, Cooper RM, Dabrowski M, Hansen PR, Almaas VM, et al. Effect of impaired cardiac conduction after alcohol septal ablation on clinical outcomes: insights from the Euro-ASA registry. Eur Hear Journal Qual Care Clin Outcomes. 2019;5:252–8.

    Article  Google Scholar 

  25. Chang SM, Nagueh SF, Spencer WH, Lakkis NM. Complete heart block: determinants and clinical impact in patients with hypertrophic obstructive cardiomyopathy undergoing nonsurgical septal reduction therapy. J Am Coll Cardiol. 2003;42:296–300.

    Article  PubMed  Google Scholar 

  26. Karimianpour A, Heizer J, Leaphart D, Rier JD, Shaji S, Ramakrishnan V, Nielsen CD, Fernandes VL, Gold MR. Predicting complete heart block after alcohol septal ablation for hypertrophic cardiomyopathy using a risk stratification model and clinical tool. Catheter Cardiovasc Interv. 2021;98:393–400.

    Article  PubMed  Google Scholar 

  27. Matsuda J, Takano H, Morooka M, Imori Y, Nakata J, Kitamura M, Tara S, Tokita Y, Yamamoto T, Takayama M, et al. Relationship between procedural right bundle branch block and 1-year outcome after alcohol septal ablation for hypertrophic obstructive cardiomyopathy - a retrospective study. Circ J. 2021;85:1481–91.

    Article  PubMed  Google Scholar 

  28. Reinhard W, Ten Cate FJ, Scholten M, De Laat LE, Vos J. Permanent pacing for complete atrioventricular block after nonsurgical (alcohol) septal reduction in patients with obstructive hypertrophic cardiomyopathy. Am J Cardiol. 2004;93:1064–6.

    Article  PubMed  Google Scholar 

  29. Chen AA, Palacios IF, Mela T, Yoerger DM, Picard MH, Vlahakes G, Lowry PA, Fifer MA. Acute predictors of subacute complete heart block after alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Am J Cardiol. 2006;97:264–9.

    Article  PubMed  Google Scholar 

  30. Majewski JP, Lelakowski J. Pacemaker dependency: how should it be defined? Europace. 2018;20:1708.

    Article  PubMed  Google Scholar 

  31. Korantzopoulos P, Letsas KP, Grekas G, Goudevenos JA. Pacemaker dependency after implantation of electrophysiological devices. Europace. 2009;11:1151–5.

    Article  PubMed  Google Scholar 

  32. Sharma E, Chu AF. Predictors of right ventricular pacing and pacemaker dependence in transcatheter aortic valve replacement patients. J Interv Card Electrophysiol. 2018;51:77–86.

    Article  PubMed  Google Scholar 

  33. Veselka J, Faber L, Liebregts M, Cooper R, Januska J, Kashtanov M, Dabrowski M, Hansen PR, Seggewiss H, Bonaventura J, et al. Alcohol dose in septal ablation for hypertrophic obstructive cardiomyopathy. Int J Cardiol. 2021;333:127–32.

    Article  PubMed  Google Scholar 

  34. Kashtanov MG, Rzhannikova AD, Chernyshev SD, Kardapoltsev LV, Idov EM, Berdnikov SV, Kochmasheva VV. Outcomes of hypertrophic obstructive cardiomyopathy patients undergoing alcohol septal ablation with a standard 3 mL dose of ethanol: Focus on long-term safety. Catheter Cardiovasc Interv. 2020;95:1212–8.

    Article  PubMed  Google Scholar 

  35. Kimmelstiel C, Rowin EJ. Fixed, high-volume alcohol dose for septal ablation: high risk with no benefit. Catheter Cardiovasc Interv. 2020;95:1219–20.

    Article  PubMed  Google Scholar 

  36. Sathyamurthy I, Nayak R, Oomman A, Subramanyan K, Kalarical MS, Mao R, Ramachandran P. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy - 8 years follow up. Indian Heart J. 2014;66:57–63.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

We thank Eyal Ben-Assa, Rasha Al-Bawardy, and Dhaval Kolte for their contributions to complete the database.

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Authors and Affiliations

  1. Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Weeranun D. Bode & Theofanie Mela

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Weeranun D. Bode & Megan Zhao

  3. Division of Cardiology, Temple University, Philadelphia, PA, USA

    Michael F. Bode

  4. Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Megan Zhao, Igor Palacios, Rahul Sakhuja, Michael A. Fifer & Theofanie Mela

  5. Hypertrophic Cardiomyopathy Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Michael A. Fifer

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Correspondence to Weeranun D. Bode.

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The study protocol was approved by the Mass General Brigham Institutional Review Board.

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Competing interests

Weeranun Bode, Michael Bode, Megan Zhao, Michael A. Fifer, Igor Palacios, Rahul Sakhuja — none

Theofanie Mela — Abbott, Biotronik, Medtronic speaker honoraria and Biotronik, Medtronic, Spectranetics consultation fees

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Bode, W.D., Bode, M.F., Zhao, M. et al. Predictors of cardiovascular implantable electronic device dependence at long-term follow-up after alcohol septal ablation in hypertrophic cardiomyopathy patients. J Interv Card Electrophysiol 66, 2071–2080 (2023). https://doi.org/10.1007/s10840-023-01532-w

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  • DOI: https://doi.org/10.1007/s10840-023-01532-w

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