JACC
HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
 QUICK SEARCH:   [advanced]


     


J Am Coll Cardiol, 2003; 42:296-300, doi:10.1016/S0735-1097(03)00623-5
© 2003 by the American College of Cardiology Foundation
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Chang, S. M.
Right arrow Articles by Lakkis, N. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Chang, S. M.
Right arrow Articles by Lakkis, N. M.

CLINICAL RESERCH: HYPERTROPHIC CARDIOMYOPATHY

Complete heart block: determinants and clinical impact in patients with hypertrophic obstructive cardiomyopathy undergoing nonsurgical septal reduction therapy

Su Min Chang, MD*, Sherif F. Nagueh, MD*, William H. Spencer, III, MD* and Nasser M. Lakkis, MD*,*

* Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA

Manuscript received January 14, 2003; revised manuscript received April 11, 2003, accepted April 17, 2003.

* Reprint requests and correspondence: Dr. Nasser M. Lakkis, Section of Cardiology, Department of Medicine, Baylor College of Medicine, 6550 Fannin, SM 677, Houston, Texas 77030, USA.
nlakkis{at}bcm.tmc.edu

OBJECTIVES: The purpose of this paper is to examine the incidence and determinants of permanent complete heart block (CHB) after nonsurgical septal reduction therapy (NSRT), and to evaluate the clinical impact of permanent pacemaker (PPM) placement.

BACKGROUND: Nonsurgical septal reduction therapy with ethanol improves the clinical and hemodynamic parameters in patients with symptomatic hypertrophic obstructive cardiomyopathy. Complete heart block is a common complication after NSRT.

METHODS: The database of 261 consecutive patients who underwent NSRT at Baylor College of Medicine was reviewed. Clinical variables that were considered as possible determinants for CHB after NSRT were: age, gender, New York Heart Association (NYHA) functional class, left ventricular outflow tract (LVOT) gradient at rest or with provocation, septal thickness, and baseline exercise duration. For electrocardiographic (ECG) variables, the presence of first-degree atrioventricular (AV) block, bifascicular block, left bundle branch block, atrial fibrillation, and left ventricular hypertrophy were analyzed. In addition, the volume of ethanol injected, the method of administration of ethanol (i.e., bolus vs. slow injection [over 30 to 60 s]), number of septal arteries occluded, use of myocardial echocardiography, and infarct size as determined by peak creatine kinase level.

RESULTS: Of 261 consecutive patients, 37 had PPM or automatic implantable cardiac defibrillator placed before NSRT. Of the remaining 224 patients, 31 (14%) developed CHB after the procedure. Multivariate logistic regression analysis showed that female gender (odds ratio [OR] 4.3; p = 0.02), bolus injection of ethanol (OR 51; p = 0.004), injecting more than one septal artery (OR 4.6; p = 0.016), the presence of left bundle branch block (OR 39; p = 0.002), and first-degree AV block (OR 14; p = 0.001) on the baseline ECG are independent predictors of CHB after NSRT. Patients requiring PPM placement had a similar improvement in their NYHA functional class, septal thickness reduction, LVOT gradient reduction, and improvement of exercise capacity when compared with patients who did not require pacing.

CONCLUSIONS: Multiple demographic, electrocardiographic, and technical factors seem to increase the risk of CHB after NSRT. Patients with CHB after NSRT derive similar clinical and hemodynamic benefit to patients who did not require permanent pacing.

Abbreviations and Acronyms
  AV
  atrioventricular
  CHB
  complete heart block
  CK
  creatine kinase
  ECG
  electrocardiogram/electrocardiographic
  HOCM
  hypertrophic obstructive cardiomyopathy
  LVOT
  left ventricular outflow tract
  MCE
  myocardial contrast echocardiography
  NSRT
  nonsurgical septal reduction therapy
  NYHA
  New York Heart Association
  OR
  odds ratio
  PPM
  permanent pacemaker




This article has been cited by other articles:


Home page
Eur Heart JHome page
M. Togni, M. Billinger, S. Cook, and O. M. Hess
Septal myectomy: cut, coil, or boil?
Eur. Heart J., February 1, 2008; 29(3): 296 - 298.
[Full Text] [PDF]


Home page
Eur Heart JHome page
E. Durand, E. Mousseaux, P. Coste, R. Pilliere, O. Dubourg, L. Trinquart, G. Chatellier, A. Hagege, M. Desnos, and A. Lafont
Non-surgical septal myocardial reduction by coil embolization for hypertrophic obstructive cardiomyopathy: early and 6 months follow-up
Eur. Heart J., February 1, 2008; 29(3): 348 - 355.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Roentgenol.Home page
M. W. Hansen and N. Merchant
MRI of Hypertrophic Cardiomyopathy: Part 2, Differential Diagnosis, Risk Stratification, and Posttreatment MRI Appearances
Am. J. Roentgenol., December 1, 2007; 189(6): 1344 - 1352.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
E. Cingolani, G. A. Ramirez Correa, E. Kizana, M. Murata, H. C. Cho, and E. Marban
Gene Therapy to Inhibit the Calcium Channel {beta} Subunit: Physiological Consequences and Pathophysiological Effects in Models of Cardiac Hypertrophy
Circ. Res., July 20, 2007; 101(2): 166 - 175.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
T. Lawrenz, F. Lieder, M. Bartelsmeier, C. Leuner, B. Borchert, D. Meyer zu Vilsendorf, C. Strunk-Mueller, J. Reinhardt, A. Feuchtl, C. Stellbrink, et al.
Predictors of Complete Heart Block After Transcoronary Ablation of Septal Hypertrophy: Results of a Prospective Electrophysiological Investigation in 172 Patients With Hypertrophic Obstructive Cardiomyopathy
J. Am. Coll. Cardiol., June 19, 2007; 49(24): 2356 - 2363.
[Abstract] [Full Text] [PDF]


Home page
HeartHome page
C. J Knight
Alcohol septal ablation for obstructive hypertrophic cardiomyopathy.
Heart, September 1, 2006; 92(9): 1339 - 1344.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
D. R. Talreja, R. A. Nishimura, W. D. Edwards, U. S. Valeti, S. R. Ommen, A. J. Tajik, J. A. Dearani, H. V. Schaff, and D. R. Holmes Jr
Alcohol septal ablation versus surgical septal myectomy: Comparison of effects on atrioventricular conduction tissue
J. Am. Coll. Cardiol., December 21, 2004; 44(12): 2329 - 2332.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
M. Murata, E. Cingolani, A. D. McDonald, J. K. Donahue, and E. Marban
Creation of a Genetic Calcium Channel Blocker by Targeted Gem Gene Transfer in the Heart
Circ. Res., August 20, 2004; 95(4): 398 - 405.
[Abstract] [Full Text] [PDF]


Home page
Journal Watch CardiologyHome page
Predicting Complete Heart Block After Alcohol Septal Ablation
Journal Watch Cardiology, August 29, 2003; 2003(829): 4 - 4.
[Full Text]




HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK
Copyright © 2003 by the American College of Cardiology Foundation.