Late Complications after Alcohol Septal Ablation in a Patient with Hypertrophic Obstructive Cardiomyopathy
1 Clinic of Cardiology, Institute of Cardiovascular Diseases, 13A G. Adam Str., 300310 Timișoara, Romania; (L.P.); (M.M.); (L.I.); (P.B.); (A.P.); (C.M.); (S.P.)
2 Department of Cardiology (VI), Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timișoara, Romania
3 Center for Translational Research and Systems Medicine, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timișoara, Romania;
4 Department of Functional Sciences-Pathophysiology, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timișoara, Romania
* Correspondence:
* Author to whom correspondence should be addressed.
Received: 10 Dec 2020 / Revised: 19 Jan 2021 / Accepted: 19 Jan 2021 / Published: 25 Jan 2021
Abstract
(1) Background: Complete atrioventricular block is a well-known complication of alcohol ablation as a septal reduction therapy, implemented in selected patients with hypertrophic obstructive cardiomyopathy (HOCM). It usually occurs during or immediately after the intervention. Rare cases of late complete atrioventricular block (CAVB) have been reported, but data are still scarce in the literature regarding this issue. (2) Case report: We report the case of a 70-year-old male patient, with mild aortic stenosis, but with a significantly degenerated valve and perivalvular tissue, and a nonspecific intraventricular conduction delay, which developed intensely symptomatic CAVB, four months after alcohol septal ablation (ASA) for HOCM, along with left ventricular pressure gradient recurrence. Both problems were resolved by implantation of a dual chamber pacemaker, with pacing optimization to a short atrioventricular interval, along with a maximal tolerated betablocker therapy. With the description of the patient’s treatment and evolution in comparison with other reports and studies, this case report highlights the fact that a close clinical, electrical and echocardiographic surveillance is warranted for this kind of patients, as late CAVB may be a life-threatening complication. Previous electrical conduction problems and degenerated aortic valve and perivalvular tissue may be predisposed for this type of complication, independent of betablocker therapy. This treatment has several other beneficial effects and thus it should not be interrupted after the procedure.
Keywords: obstructive hypertrophic cardiomyopathy; alcohol septal ablation; abnormal electrical conduction; late complete AV block; LVOT pressure gradient recurrence; dual chamber pacemaker implantation
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CITE
Șoșdean, R.; Pașcalău, L.; Mircea, M.; Ionică, L.; Baneu, P.; Pescariu, A.; Sturza, A.; Mornoș, C.; Pescariu, S. Late Complications after Alcohol Septal Ablation in a Patient with Hypertrophic Obstructive Cardiomyopathy. Timisoara_Med 2021, 2020, 3.
Șoșdean R, Pașcalău L, Mircea M, Ionică L, Baneu P, Pescariu A, Sturza A, Mornoș C, Pescariu S. Late Complications after Alcohol Septal Ablation in a Patient with Hypertrophic Obstructive Cardiomyopathy. Timisoara Medical Journal. 2021; 2020(2):3.
Șoșdean, Raluca; Pașcalău, Laurențiu; Mircea, Monica; Ionică, Loredana; Baneu, Petru; Pescariu, Alexandru; Sturza, Adrian; Mornoș, Cristian; Pescariu, Sorin. 2021. "Late Complications after Alcohol Septal Ablation in a Patient with Hypertrophic Obstructive Cardiomyopathy." Timisoara_Med 2020, no. 2: 3.
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