Acute decompensation of hypertrophic obstructive cardiomyopathy secondary to A-V disassociation: successful treatment with a combination of alcohol septal ablation and permanent pacemaker.

Alcohol septal ablation is increasingly being offered as a therapy for patients with hypertrophic obstructive cardiomyopathy. The procedure is most often performed in stable patients with a history of increasing symptoms. We describe a patient with hypertrophic obstructive cardiomyopathy with an acute decompensation secondary to the development of complete heart block. The patient's hemodynamics demonstrates the importance of atrial-ventricular (A-V) synchrony in this disease process. This case report is also a unique description of alcohol septal ablation being performed emergently to improve hemodynamics and the urgent implantation of a permanent pacemaker to return A-V synchrony. (J Interven Cardiol 2005;18:401-406).