I read with interest a study by Balt et al. (1) concluding that among
patients who underwent alcohol septal ablation (ASA) for hypertrophic
obstructive cardiomyopathy (HOCM) only 7% of patients experienced
malignant tachyarrhythmia (VT/VF) in the first post-ASA month, while no
VT/VF were observed later. I wish to support their study and comment on
our own experience dealing with this topic.
Based on multi-centre and multi-national European study (2), we know that
the development of ventricular arrhythmias early after ASA is not rare and
the early post-ASA period can be compared to the same period after acute
myocardial infarction. We found in-hospital VT/VF requiring immediate
electrical cardioversion in 1% of cases. Therefore, patients after ASA
require close ECG monitoring for at least five post-procedural days (2).
However, among patients with early post-procedural VT/VF there were no
further adverse clinical events. Thus, one may speculate that most of
early post-ASA ventricular arrhythmias are related to the procedure and
have no further clinical consequences (2).
A major concern associated with ASA is potentially increased risk of
sudden cardiac death in long-term follow-up. Recently, several studies
have demonstrated post-ASA survival similar to the expected survival of
age- and sex-matched general population (3-4). Moreover, causes of deaths
were determined with predominance of non-cardiac death (4).
Therefore, authors of the recent paper in the Heart should be
congratulated on further evidence of relative long-term safety of ASA.
1. Balt JC, Wijffels MC, Boersma LV, Wever EF, Ten berg JM.
Continuous rhythm monitoring for ventricular arrhythmias after alcohol
septal ablation for hypertrophic cardiomyopathy. Heart 2014 Jul 29.pii:
heartjnl-2014-305593.
2. Veselka J, Lawrenz T, Stellbrink C, et al. Low incidence of procedure-
related major adverse cardiac events after alcohol septal ablation for
symptomatic hypertrophic obstructive cardiomyopathy. Can J Cardiol
2013;29:1415-21.
3. Jensen MK, Prinz C, Hortskotte D, et al. Alcohol septal ablation in
patients with hypertrophic obstructive cardiomyopathy: low incidence of
sudden death and reduced risk profile. Heart 2013;99:1012-7.
4. Veselka J, Krejci J, Tomasov P, Zemanek D. Long-term survival after
alcohol septal ablation for hypertrophic obstructive cardiomyopathy: A
comparison with general population. Eur Heart J 2014;35: 2040-5.
Conflict of Interest:
None declared
I read with interest a study by Balt et al. (1) concluding that among patients who underwent alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) only 7% of patients experienced malignant tachyarrhythmia (VT/VF) in the first post-ASA month, while no VT/VF were observed later. I wish to support their study and comment on our own experience dealing with this topic. Based on multi-centre and multi-national European study (2), we know that the development of ventricular arrhythmias early after ASA is not rare and the early post-ASA period can be compared to the same period after acute myocardial infarction. We found in-hospital VT/VF requiring immediate electrical cardioversion in 1% of cases. Therefore, patients after ASA require close ECG monitoring for at least five post-procedural days (2). However, among patients with early post-procedural VT/VF there were no further adverse clinical events. Thus, one may speculate that most of early post-ASA ventricular arrhythmias are related to the procedure and have no further clinical consequences (2). A major concern associated with ASA is potentially increased risk of sudden cardiac death in long-term follow-up. Recently, several studies have demonstrated post-ASA survival similar to the expected survival of age- and sex-matched general population (3-4). Moreover, causes of deaths were determined with predominance of non-cardiac death (4). Therefore, authors of the recent paper in the Heart should be congratulated on further evidence of relative long-term safety of ASA.
1. Balt JC, Wijffels MC, Boersma LV, Wever EF, Ten berg JM. Continuous rhythm monitoring for ventricular arrhythmias after alcohol septal ablation for hypertrophic cardiomyopathy. Heart 2014 Jul 29.pii: heartjnl-2014-305593. 2. Veselka J, Lawrenz T, Stellbrink C, et al. Low incidence of procedure- related major adverse cardiac events after alcohol septal ablation for symptomatic hypertrophic obstructive cardiomyopathy. Can J Cardiol 2013;29:1415-21. 3. Jensen MK, Prinz C, Hortskotte D, et al. Alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy: low incidence of sudden death and reduced risk profile. Heart 2013;99:1012-7. 4. Veselka J, Krejci J, Tomasov P, Zemanek D. Long-term survival after alcohol septal ablation for hypertrophic obstructive cardiomyopathy: A comparison with general population. Eur Heart J 2014;35: 2040-5.
Conflict of Interest:
None declared