Delayed occurrence of complete heart block without warning after alcohol septal ablation for hypertrophic obstructive cardiomyopathy

Percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy: Managing the risk of procedure-related AV conduction disturbances

“…However, in contrast to previous publications, we did not observe any 90-day mortality in this cohort, covering 5 years and 155 consecutive patients. We speculate that the proposed risk scoring system has contributed to this zero complication rate [20,21,24].…”

“…One of the significant disadvantages of septal ablation as compared to myectomy is the higher rate of reported AV conduction problems in some series, ranging up to 30% [7][8][9][10][11][15][16][17][18][19][20][21][22][23][24]. Although all leading groups in this field have observed a trend towards fewer and less severe conduction problems after reducing the ethanol dose [8][9][10][11], AV conduction disturbance is still the most frequent acute complication of percutaneous septal ablation, occurring in about 50% of cases during or immediately after the intervention.…”

“…Atrioventricular (AV) conduction disturbances requiring transient or permanent pacing are reported in a substantial proportion of patients undergoing this treatment [16][17][18][19][20]. Consequently, placement of a temporary pacemaker lead is a mandatory part of the intervention protocol.…”

ACCF/AHA/SCAI 2007 Update of the Clinical Competence Statement on Cardiac Interventional Procedures

“…Physicians performing these procedures should have extensive knowledge of the outcomes, limitations and complications of medical therapy (104), dual chamber pacing and surgical myectomy (105)(106)(107), and alcohol septal ablation (105)(106)(107)(108)(109)(110)(111)(112)(113)(114). No comparative trial against surgical myectomy has been performed.…”

Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy: How much alcohol should be injected?

“…Because normal sinus rhythm has been reported to return as late as 13 days after the development of post-PTSMA complete heart block [9], a conservative approach should be followed [9,10]. Furthermore, delayed occurrence of complete heart block without warning has been reported [7,11]. Therefore, we routinely kept the temporary pacing wire in the right ventricle for 3-7 days after PTSMA [3] and refrained from permanent pacemaker implantation before 13 days after PTSMA [10].…”