Arq Bras Cardiol: Imagem cardiovasc. 2024; 37(3): e20240013
New Predictor of Ventricular Arrhythmia After Alcohol Septal Ablation: Preoperative Inferolateral Wall Thickness
DOI: 10.36660/abcimg.20240013i
Abstract
Introduction:
Predictors of arrhythmias and sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM) have been identified. However, they have not been validated after alcohol septal ablation (ASA). Data to predict the occurrence of arrhythmia after the procedure are not certain.
Objectives:
To retrospectively analyze patients who underwent ASA and to determine the predictors of post-op ventricular arrhythmia.
Patients and Methods:
We retrospectively enrolled 53 consecutive patients with HCM who underwent ASA procedure due to symptomatic left ventricular outflow tract (LVOT) obstruction despite maximally tolerated medical treatment between January 2010 and December 2022. P < 0.05 was considered statistically significant.
Results:
The mean age of the patients was 56.45 years, and 55% were male. Patients underwent successful ASA, and an average of 1.76 cc of alcohol was used. A 70.81% reduction in LVOT gradients was achieved. No pathological LVOT gradient was observed in any patient after the procedure. In the postprocedural follow-up, total atrioventricular block was detected in 12 patients and implantable cardiac defibrillator (ICD) implantation was performed in these patients. When patients with ventricular arrhythmias after successful ASA were compared with those without it, preoperative hypertrophic cardiomyopathy risk of sudden cardiac death (HCMSCD) Score > 6 and left ventricular inferolateral wall thickness were statistically different between the two groups (p: 0.049, p: 0.006, respectively). When multi-logistic regression was performed, basal left ventricular inferolateral wall thickness > 15.5 mm was found to be an independent risk factor for ventricular arrhythmia after ASA (p: 0.027).
Conclusions:
Left ventricular inferolateral wall thickness is an independent predictor of ventricular arrhythmia after ASA. It can be used in postprocedural patient follow-up and ICD decision-making.
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