Conduction system abnormalities in patients with obstructive hypertrophic cardiomyopathy following septal reduction interventions - 26/08/11
, Craig R Asher, MD a, Zoran B Popović, MD a, Neil L Greenberg, PhD a, Deborah A Agler, RDCS a, Jeanne K Drinko, RDCS a, Nicholas G Smedira, MD b, E.Murat Tuzcu, MD a, Bruce W Lytle, MD b, James D Thomas, MD aAbstract |
We observed the impact of percutaneous transluminal septal myocardial ablation (PTSMA) and myectomy on the conduction system in patients with obstructive hypertrophic cardiomyopathy (HC). Septal reduction intervention is capable of eliminating the left ventricular outflow tract obstruction in patients with obstructive HC; however, conduction system abnormalities are frequent consequences of these procedures. A standard 12-lead electrocardiogram and Doppler echocardiogram were obtained in 204 patients who underwent PTSMA (n = 70) or myectomy (n = 134) before and at average of 3 months after intervention. Of 146 patients who had normal conduction systems before intervention, the duration of the QRS complex was significantly prolonged from 98 ± 15 to 130 ± 25 ms (p <0.0001), with right bundle branch block (RBBB) developing in 62% patients after PTSMA, and from 100 ± 13 to 154 ± 20 ms (p <0.0001), with left bundle branch block (LBBB) developing in 93% patients after myectomy. No significant difference in the QRS duration was found in the remaining 58 patients who had preexisting conduction abnormalities after intervention. In 174 patients without a preexisting permanent pacemaker, a pacemaker was implanted in 22% versus 13% of patients who underwent PTSMA (overall and without preexisting conduction block, respectively) and 10% versus 2% of patients with myectomy. The duration of baseline QRS was an independent predictor for the requirement of a permanent pacemaker (p <0.0001). Thus, RBBB often develops after PTSMA and LBBB is very frequently produced by myectomy. A possible requirement of a permanent pacemaker should always be considered before intervention when patients have preexisting RBBB or LBBB.
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 | This study was supported in part by grant NCC9-58 from the National Aeronautics and Space Administration, Houston, Texas, and by grant USAMRMC #02360007 from the Department of Defense, Fort Detrick, Maryland. Manuscript received April 10, 2003; revised manuscript received and accepted September 23, 2003. |
Vol 93 - N° 2
P. 171-175 - janvier 2004 Retour au numéro
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- Comparison of left atrial volume and function after linear ablation and after cardioversion for chronic atrial fibrillation
- Liza Thomas, Stuart P. Thomas, Michelle Hoy, Anita Boyd, Nelson B. Schiller, David L. Ross
- PROFESSOR Sir Magdi Habib Yacoub, FRS, FRCS, FRCP, DS: a conversation with the editor
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