Effect of impaired cardiac conduction after alcohol septal ablation on clinical outcomes: insights from the Euro-ASA registry

Authors	JENSEN Morten Kvistholm FABER Lothar LIEBREGTS Max JANUSKA Jaroslav KREJČÍ Jan BARTEL Thomas COOPER Robert M. DABROWSKI Maciej HANSEN Peter Riis ALMAAS Vibeke Marie SEGGEWISS Hubert HORSTKOTTE Dieter ADLOVA Radka TEN BERG Jurrien BUNDGAARD Henning VESELKA Josef
Year of publication	2019
Type	Article in Periodical
Magazine / Source	EUROPEAN HEART JOURNAL-QUALITY OF CARE AND CLINICAL OUTCOMES
MU Faculty or unit	Faculty of Medicine
Citation
Web	http://dx.doi.org/10.1093/ehjqcco/qcy049
Doi	http://dx.doi.org/10.1093/ehjqcco/qcy049
Keywords	Hypertrophic cardiomyopathy; Alcohol septal ablation; Pacemaker; Implantable cardioverter-defibrillator; Bundle branch block; Cardiac conduction; Survival
Description	Aims We analysed the impact of bundle branch block (BBB) and pacemaker (PM) implantation on symptoms and survival after alcohol septal ablation (ASA) in patients with hypertrophic cardiomyopathy (HCM). Methods and results Among 1416 HCM patients from the Euro-ASA registry, 58 (4%) patients had a PM and 64 (5%) patients had an implantable cardioverter-defibrillator (ICD) before ASA. At latest follow-up (5.0 +/- 4.0 years) after ASA, 118 (8%) patients had an ICD and 229 (16%) patients had a PM. In patients without an implantable device prior to ASA 13% had a PM and 5% had an ICD implanted following ASA. New onset BBB was present in 44% (right BBB in 31%) of patients without previous BBB. At latest follow-up, we found no associations between BBB and New York Heart Association (NYHA) Class 3-4 [odds ratio (OR) 0.98, 95% confidence interval (CI) 0.63-1.51; P = 0.91] or Canadian Cardiovascular Society (CCS) Class 3-4 (OR 1.5, CI 0.32-6.7; P = 0.62), respectively, and no associations between PM and NYHA Class 3-4 (OR 1.2, CI 0.70-2.0; P = 0.52) or CCS 3-4 (OR 1.3, CI 0.24-6.6; P = 0.79), respectively. The survival after ASA was not reduced in patients with BBB [hazard ratio (HR) 0.73, CI 0.53-1.01; P = 0.06] or PM (HR 0.78, CI 0.52-1.17; P = 0.24). Conclusions Development of BBB or need for a PM after ASA in patients with obstructive HCM was not associated with inferior symptomatic outcome or reduced survival, thus concerns for the negative impact of impaired cardiac conduction on the clinical outcome after ASA were not confirmed.