PMID- 12875767
OWN - NLM
STAT- MEDLINE
DCOM- 20030820
LR  - 20190708
IS  - 0735-1097 (Print)
IS  - 0735-1097 (Linking)
VI  - 42
IP  - 2
DP  - 2003 Jul 16
TI  - Complete heart block: determinants and clinical impact in patients with 
      hypertrophic obstructive cardiomyopathy undergoing nonsurgical septal reduction 
      therapy.
PG  - 296-300
AB  - OBJECTIVES: The purpose of this paper is to examine the incidence and 
      determinants of permanent complete heart block (CHB) after nonsurgical septal 
      reduction therapy (NSRT), and to evaluate the clinical impact of permanent 
      pacemaker (PPM) placement. BACKGROUND: Nonsurgical septal reduction therapy with 
      ethanol improves the clinical and hemodynamic parameters in patients with 
      symptomatic hypertrophic obstructive cardiomyopathy. Complete heart block is a 
      common complication after NSRT. METHODS: The database of 261 consecutive patients 
      who underwent NSRT at Baylor College of Medicine was reviewed. Clinical variables 
      that were considered as possible determinants for CHB after NSRT were: age, 
      gender, New York Heart Association (NYHA) functional class, left ventricular 
      outflow tract (LVOT) gradient at rest or with provocation, septal thickness, and 
      baseline exercise duration. For electrocardiographic (ECG) variables, the 
      presence of first-degree atrioventricular (AV) block, bifascicular block, left 
      bundle branch block, atrial fibrillation, and left ventricular hypertrophy were 
      analyzed. In addition, the volume of ethanol injected, the method of 
      administration of ethanol (i.e., bolus vs. slow injection [over 30 to 60 s]), 
      number of septal arteries occluded, use of myocardial echocardiography, and 
      infarct size as determined by peak creatine kinase level. RESULTS: Of 261 
      consecutive patients, 37 had PPM or automatic implantable cardiac defibrillator 
      placed before NSRT. Of the remaining 224 patients, 31 (14%) developed CHB after 
      the procedure. Multivariate logistic regression analysis showed that female 
      gender (odds ratio [OR] 4.3; P = 0.02), bolus injection of ethanol (OR 51; P = 
      0.004), injecting more than one septal artery (OR 4.6; P = 0.016), the presence 
      of left bundle branch block (OR 39; P = 0.002), and first-degree AV block (OR 14; 
      P = 0.001) on the baseline ECG are independent predictors of CHB after NSRT. 
      Patients requiring PPM placement had a similar improvement in their NYHA 
      functional class, septal thickness reduction, LVOT gradient reduction, and 
      improvement of exercise capacity when compared with patients who did not require 
      pacing. CONCLUSIONS: Multiple demographic, electrocardiographic, and technical 
      factors seem to increase the risk of CHB after NSRT. Patients with CHB after NSRT 
      derive similar clinical and hemodynamic benefit to patients who did not require 
      permanent pacing.
FAU - Chang, Su Min
AU  - Chang SM
AD  - Section of Cardiology, Department of Medicine, Baylor College of Medicine, 
      Houston, Texas 77030, USA.
FAU - Nagueh, Sherif F
AU  - Nagueh SF
FAU - Spencer, William H 3rd
AU  - Spencer WH 3rd
FAU - Lakkis, Nasser M
AU  - Lakkis NM
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 3K9958V90M (Ethanol)
SB  - IM
MH  - Aged
MH  - Cardiomyopathy, Hypertrophic/diagnostic imaging/physiopathology/*surgery
MH  - Catheter Ablation/*adverse effects/methods
MH  - Echocardiography
MH  - Electrocardiography
MH  - Ethanol
MH  - Female
MH  - Heart Block/diagnosis/epidemiology/*etiology/therapy
MH  - Heart Septum/*surgery
MH  - Hemodynamics
MH  - Humans
MH  - Incidence
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Pacemaker, Artificial
MH  - Predictive Value of Tests
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Treatment Outcome
EDAT- 2003/07/24 05:00
MHDA- 2003/08/21 05:00
CRDT- 2003/07/24 05:00
PHST- 2003/07/24 05:00 [pubmed]
PHST- 2003/08/21 05:00 [medline]
PHST- 2003/07/24 05:00 [entrez]
AID - S0735109703006235 [pii]
AID - 10.1016/s0735-1097(03)00623-5 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2003 Jul 16;42(2):296-300. doi: 10.1016/s0735-1097(03)00623-5.