This Article Figures Only Full Text Full Text (PDF) View Related Cardiosource Journal Scan Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (7) Citing Articles via Google Scholar Google Scholar Articles by Cuoco, F. A. Articles by Gold, M. R. Search for Related Content PubMed PubMed Citation Articles by Cuoco, F. A. Articles by Gold, M. R. Related Collections Related Article

CLINICAL RESEARCH: CARDIOMYOPATHY

Implantable Cardioverter-Defibrillator Therapy for Primary Prevention of Sudden Death After Alcohol Septal Ablation of Hypertrophic Cardiomyopathy

Medical University of South Carolina, Charleston, South Carolina

Manuscript received April 21, 2008; revised manuscript received July 7, 2008, accepted July 23, 2008.

^_* Reprint requests and correspondence: Dr. Frank A. Cuoco, Medical University of South Carolina, Cardiac Electrophysiology, 25 Courtenay Drive, MSC 592, Charleston, South Carolina 29425 (Email: frankcuoco{at}mac.com).

Objectives: The purpose of this study was to examine the effects of alcohol septal ablation (ASA) on ventricular arrhythmias among patients with obstructive hypertrophic cardiomyopathy (HCM), as measured by appropriate implantable cardioverter-defibrillator (ICD) discharges.

Background: Alcohol septal ablation is an effective therapy for patients with symptomatic HCM. However, concern has been raised that ASA may be proarrhythmic secondary to the iatrogenic scar created during the procedure. The impact of ASA on ventricular arrhythmias has not been well described.

Methods: This prospective study included 123 consecutive patients with obstructive HCM who underwent ASA and had an ICD implanted for primary prevention of sudden cardiac death (SCD). The ICDs were implanted based on commonly accepted risk factors for SCD in the HCM population. Data from ICD interrogations during routine follow-up were collected.

Results: Nine appropriate ICD shocks were recorded over a mean follow-up of 2.9 years in the cohort, which had a mean of 1.5 ± 0.9 risk factors for SCD. Using Kaplan-Meier survival analysis, the estimated annual event rate was 2.8% over 3-year follow-up. There were no significant differences in the incidence of risk factors between patients who did and did not receive appropriate shocks.

Conclusions: The annual rate of appropriate ICD discharges after ASA is low and less than that reported previously for primary prevention of SCD in HCM. This suggests that ASA is not proarrhythmic. Traditional SCD risk factors did not predict ICD shocks in this cohort.

Key Words: hypertrophic cardiomyopathy • alcohol septal ablation • implantable cardioverter-defibrillator • sudden cardiac death

Abbreviations and Acronyms   ASA = alcohol septal ablation   AV = atrioventricular   HCM = hypertrophic cardiomyopathy   ICD = implantable cardioverter-defibrillator   LVH = left ventricular hypertrophy   LVOT = left ventricular outflow tract   NSVT = nonsustained ventricular tachycardia   SAM = systolic anterior motion   SCD = sudden cardiac death   VF = ventricular fibrillation   VT = ventricular tachycardia

Related Article

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 52: A33. [Full Text] [PDF]

This article has been cited by other articles:

				B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, H. Rakowski, et al. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 13, 2011; 58(25): 2703 - 2738. [Full Text] [PDF]

				B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, H. Rakowski, 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 Developed in Collaboration With the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., December 13, 2011; 58(25): e212 - e260. [Full Text] [PDF]

				Writing Committee Members, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, 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, December 13, 2011; 124(24): e783 - e831. [Full Text] [PDF]

				Writing Committee Members, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, et al. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, December 13, 2011; 124(24): 2761 - 2796. [Full Text] [PDF]

				Writing Committee Members:*, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines J. Thorac. Cardiovasc. Surg., December 1, 2011; 142(6): 1303 - 1338. [Full Text] [PDF]

				Writing Committee Members:*, B. J. Gersh, B. J. Maron, R. O. Bonow, J. A. Dearani, M. A. Fifer, M. S. Link, S. S. Naidu, R. A. Nishimura, S. R. Ommen, 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 J. Thorac. Cardiovasc. Surg., December 1, 2011; 142(6): e153 - e203. [Full Text] [PDF]

				B. J. Maron, M. Yacoub, and J. A. Dearani Benefits of surgery in obstructive hypertrophic cardiomyopathy: bring septal myectomy back for European patients Eur. Heart J., May 1, 2011; 32(9): 1055 - 1058. [Abstract] [Full Text] [PDF]

				M. A. Fifer and U. Sigwart Hypertrophic obstructive cardiomyopathy: alcohol septal ablation Eur. Heart J., May 1, 2011; 32(9): 1059 - 1064. [Abstract] [Full Text] [PDF]

				J. ten Berg, R. C. Steggerda, and H.-M. J. Siebelink The patient with hypertrophic cardiomyopathy Heart, November 1, 2010; 96(21): 1764 - 1772. [Full Text] [PDF]

				F. J. ten Cate, O. I. I. Soliman, M. Michels, D. A. M. J. Theuns, P. L. de Jong, M. L. Geleijnse, and P. W. Serruys Long-Term Outcome of Alcohol Septal Ablation in Patients With Obstructive Hypertrophic Cardiomyopathy: A Word of Caution Circ Heart Fail, May 1, 2010; 3(3): 362 - 369. [Abstract] [Full Text] [PDF]

				I. Christiaans, K. van Engelen, I. M. van Langen, E. Birnie, G. J. Bonsel, P. M. Elliott, and A. A.M. Wilde Risk stratification for sudden cardiac death in hypertrophic cardiomyopathy: systematic review of clinical risk markers Europace, March 1, 2010; 12(3): 313 - 321. [Abstract] [Full Text] [PDF]

				S. Agarwal, E. M. Tuzcu, M. Y. Desai, N. Smedira, H. M. Lever, B. W. Lytle, and S. R. Kapadia Updated Meta-Analysis of Septal Alcohol Ablation Versus Myectomy for Hypertrophic Cardiomyopathy J. Am. Coll. Cardiol., February 23, 2010; 55(8): 823 - 834. [Abstract] [Full Text] [PDF]

				B. J. Maron Contemporary Insights and Strategies for Risk Stratification and Prevention of Sudden Death in Hypertrophic Cardiomyopathy Circulation, January 26, 2010; 121(3): 445 - 456. [Full Text] [PDF]

				C. Knight and S. A. Mohiddin Chapter 41 Alcohol septal ablation for obstructive hypertrophic cardiomyopathy Oxford Textbook of Interventional Cardiology, January 1, 2010; 1(1): med-9780199569083-chapter - med-9780199569083-chapter. [Abstract] [Full Text]