Electrocardiographic Changes Following Percutaneuos Alcohol Septal Ablation for Hypertrophic Cardiomyopathy

摘要

Percutaneous Transluminal Alcohol Septal Ablation (PTSA) of the hypertrophied septum for patients with Hypertrophic Obstructive Cardiomyopathy (HOCM) is an effective and safe endovascular non-surgical therapeutic intervention. We report a detailed analysis of Electrocardiographic (ECG) changes associated with PTSA immediately and a mean of 164 days after the procedure in 25 patients. A subgroup of 9 patients had long term follow up with mean of 360 days (108-783days). We correlated the ECG changes with hemodynamic and structural measurements on serial echocardiograms. We retrospectively reviewed the records of 25 patients who underwent PTSA for symptomatic HOCM in our tertiary center between 3/2001 and 5/2003. All patients had ECGs and echocardiograms pre, immediately post-PTSA and at follow-up evaluations. All patients had improvement in left ventricular outflow tract gradient, interventricular septal thickness and left atrial diameter. Baseline NYHA functional class of 2.8?0.7 improved post-PTSA to 1.1?1.0 (p<0.001). None of the patients experienced subsequent angina. One patient developed progressive heart failure and died 1-month post-PTSA of unclear etiology. Four (16%) patients required permanent dual chamber pacemaker implantation subsequent to the development of pacemaker dependent third degree heart block. Twelve (48%) patients developed right bundle branch block, 6 (24%) patients left anterior fascicular hemiblock, 1 (4%) patients left posterior fascicular hemiblock and no patients had new left bundle branch block. QRS duration of 113.4?32.1 msec increased 23% to 140.3?27.9 msec (p<0.0001) immediate post-PTSA. QTc interval prolonged from the baseline of 453.9?37.3 msec to 491.3?52.6 msec (p<0.016) immediately post-PTSA. Nine patients had over 3-month follow-up with QTc intervals of 460.7?44.9 msec pre- and 552.6?47.8 msec (p<0.005) immediately post-PTSA. At last follow-up QTc interval decreased to 487.7?41.4 msec, which was not significantly different from the baseline. JTc interval showed no significant change from baseline immediately post PTSA or at long term follow up. New, at least 1 additional mm ST segment elevation developed in any of the anterior chest leads in four patients following the procedure. New pathological Q waves developed in leads V and V in three patients. Present data support the previous findings of the development of new anterior ST elevation, Q waves, QRS widening, RBBB, LAFHB, permanent heart block, transient QT interval prolongation. None of the ECG criteria showed statistically significant association with the measured echocardiographic parameters.