Transcoronary Ablation of Septal Hypertrophy Does Not Alter ICD Intervention Rates in High Risk Patients with Hypertrophic Obstructive Cardiomyopathy

Abstract

In conclusion, on the basis of ICD-discharge rates in HOCM-patients at high risk for sudden death, there is no evidence for an unfavorable arrhythmogenic effect of TASH. The efficacy of ICD treatment for the prevention of sudden cardiac death in HOCM could be confirmed, however, mortality is high in this cohort of hypertrophic cardiomyopathy patients.

Contemporary Insights and Strategies for Risk Stratification and Prevention of Sudden Death in Hypertrophic Cardiomyopathy

“…Although there is concern, no definitive evidence is yet available at this relatively early juncture that the alcohol septal ablation scar per se increases (or does not increase) the long-term risk for SD in absolute terms, and resolution will require greatly extended follow-up studies in large patient cohorts. 63 There is, however, a documented risk for potentially lifethreatening sustained ventricular tachyarrhythmias largely over the short-term 8,[55][56][57][58][59][60][61][62] (with reported postprocedural annual event rates of 3% to 5% 58,61 ) presumably resulting from electrical instability potentiated by the scar in certain susceptible patients. On the basis of this consideration and a measure of concern that alcohol-imposed infarcts could compound preexisting and underlying myocardial electric instability, 8,9,54,55,57,59 some practitioners have considered alcohol septal ablation a risk arbitrator and prudently implanted ICDs in selected patients with commonly accepted risk markers after the ablation procedure.…”

Outcome and Complications After Implantable Cardioverter Defibrillator Therapy in Hypertrophic Cardiomyopathy

“…Hence, the summary estimate of clinical data and outcome is based on 16 studies. 4,7,9,[12][13][14]16,[18][19][20][24][25][26][27][28]30 Thirteen (81%) studies reported on a population of patients with HCM with an ICD for primary or secondary prevention of SCD, 1 (8%) study focused on patients with HCM with an ICD for primary prevention of SCD, and 2 (13%) studies reported on patients with hypertrophic obstructive cardiomyopathy who underwent alcohol septal ablation and had received an ICD.…”

2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary

“…Patients with HCM considered to carry sufficient risk to warrant ICD placement have an annual incidence of appropriate interventions for VT/ventricular fibrillation of 3% to 10%. 150,328,332 It is uncertain how common such events are attributable to the procedure or alternatively to the underlying disease, but the incidence of sustained ventricular arrhythmias after myectomy is extremely low (0.2% to 0.9% per year). 64,295,296 Meta-analyses have indicated no difference between septal ablation and myectomy in the medium-term incidence of SCD or all-cause mortality.…”

“…144,275,324 There has been concern that the potential ventricular arrhythmogenicity of the scar created by septal ablation might augment risk in the HCM population. Several studies have documented the occurrence of sustained ventricular arrhythmias 301,314,[325][326][327][328][329][330][331] and SCD following septal ablation 296 in about 3% to 10% of patients both with or without risk factors for SCD. Patients with HCM considered to carry sufficient risk to warrant ICD placement have an annual incidence of appropriate interventions for VT/ventricular fibrillation of 3% to 10%.…”