Peter A Bleszynski1, Ilan Goldenberg2, Genaro Fernandez1, Erik Howell1, Arwa Younis3, Anita Y Chen4, Scott McNitt3, Jeffrey Bruckel1, Fred Ling1, Chris Cove1, Mehmet K Aktas5. 1. Division of Cardiology, University of Rochester Medical Center, Rochester, New York. 2. Division of Cardiology, University of Rochester Medical Center, Rochester, New York; Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York. 3. Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York. 4. Clinical Cardiovascular Research Center, University of Rochester Medical Center, Rochester, New York; Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York. 5. Division of Cardiology, University of Rochester Medical Center, Rochester, New York. Electronic address: Mehmet_Aktas@urmc.rochester.edu.
Abstract
BACKGROUND: Alcohol septal ablation (ASA) in patients with hypertrophic cardiomyopathy (HCM) can lead to heart rhythm disturbances including complete heart block (CHB) and atrial and ventricular arrhythmias. OBJECTIVE: We aimed to evaluate the utility of long-term arrhythmia monitoring with an implantable cardiac monitor (ICM) after ASA. METHODS: Between February 2014 and March 2019, 56 patients with HCM undergoing ASA were enrolled in a prospective study and underwent ICM implantation. Kaplan-Meier survival analysis was used to assess the rate of ICM-detected arrhythmic events. RESULTS: The mean age was 59 ± 11 years, and 20 (36%) were women. The median (25th, 75th percentile) resting left ventricular outflow tract gradient obtained by echocardiography was 43 (22, 81) mm Hg. Greater than 1 septal perforating artery was injected in 48 patients (86%). The Kaplan-Meier cumulative rate of ICM-detected arrhythmic events at 18 months of follow-up was 71%, with an event rate of 43% occurring within 3 months of ASA. The cumulative rate of the ICM-detected first atrial fibrillation event at 18 months was 37%, and the corresponding rate of CHB was 19%. All atrial fibrillation and CHB events were actionable, leading to the initiation of anticoagulation and pacemaker implantation, respectively. No baseline demographic or procedural variables were identified as independent predictors of an increased risk of developing ICM-detected arrhythmic events. CONCLUSION: After ASA, ICM is effective in capturing clinically actionable arrhythmic events in patients with HCM regardless of patient's baseline risk factors.
BACKGROUND:Alcohol septal ablation (ASA) in patients with hypertrophic cardiomyopathy (HCM) can lead to heart rhythm disturbances including complete heart block (CHB) and atrial and ventricular arrhythmias. OBJECTIVE: We aimed to evaluate the utility of long-term arrhythmia monitoring with an implantable cardiac monitor (ICM) after ASA. METHODS: Between February 2014 and March 2019, 56 patients with HCM undergoing ASA were enrolled in a prospective study and underwent ICM implantation. Kaplan-Meier survival analysis was used to assess the rate of ICM-detected arrhythmic events. RESULTS: The mean age was 59 ± 11 years, and 20 (36%) were women. The median (25th, 75th percentile) resting left ventricular outflow tract gradient obtained by echocardiography was 43 (22, 81) mm Hg. Greater than 1 septal perforating artery was injected in 48 patients (86%). The Kaplan-Meier cumulative rate of ICM-detected arrhythmic events at 18 months of follow-up was 71%, with an event rate of 43% occurring within 3 months of ASA. The cumulative rate of the ICM-detected first atrial fibrillation event at 18 months was 37%, and the corresponding rate of CHB was 19%. All atrial fibrillation and CHB events were actionable, leading to the initiation of anticoagulation and pacemaker implantation, respectively. No baseline demographic or procedural variables were identified as independent predictors of an increased risk of developing ICM-detected arrhythmic events. CONCLUSION: After ASA, ICM is effective in capturing clinically actionable arrhythmic events in patients with HCM regardless of patient's baseline risk factors.
Authors: Mengyao Zhou; Shengjun Ta; Rebecca T Hahn; David H Hsi; Martin B Leon; Rui Hu; Jun Zhang; Lei Zuo; Jing Li; Jing Wang; Bo Wang; Xiaoli Zhu; Jiani Liu; Yupeng Han; Xiaojuan Li; Bo Xu; Lei Zhang; Lihong Hou; Chao Han; Jincheng Liu; Liwen Liu Journal: JAMA Cardiol Date: 2022-05-01 Impact factor: 30.154
Authors: Sina Safabakhsh; Darson Du; Janet Liew; Jeremy Parker; Cheryl McIlroy; Elina Khasanova; Praveen Indraratna; Philipp Blanke; Jonathon Leipsic; Jason G Andrade; Matthew T Bennett; Nathaniel M Hawkins; Shantabanu Chakrabarti; John Yeung; Marc W Deyell; Andrew D Krahn; Robert Moss; Kevin Ong; Zachary Laksman Journal: CJC Open Date: 2021-11-11
Authors: Darson Du; Christopher O Y Li; Kevin Ong; Ashkan Parsa; Adaya Weissler-Snir; Jeffrey B Geske; Zachary Laksman Journal: CJC Open Date: 2022-01-07
Authors: Babak Nazer; David Giraud; Yan Zhao; James Hodovan; Miriam R Elman; Ahmad Masri; Edward P Gerstenfeld; Jonathan R Lindner Journal: Heart Rhythm Date: 2020-12-29 Impact factor: 6.343