Late recurrent complete heart block after alcohol septal ablation treatment for hypertrophic obstructive cardiomyopathy

Introduction: Alcohol septal ablation (ASA) therapy is recommended to patients with symphtomatic hyper-trophic obstructive cardiomiopathy (HCM) refracto-ry to drugs therapy. An important complication is the complete atrioventricular heart block (CHB) which in a significat percentage of cases is resolved up to 24 ho-urs. The late recurrent atrioventricular block after the intervention it is a fatal complication. The number of studies are limited and without clear indications regar-ding the postprocedural patients monitoring.

Objective: Our aim is to report the case of a hyper-trophic obstructive cardiomiopathy with cardiorespi-ratory arrest through a complete atrioventricular block with ventricular asystole describing the management and patient evolution. ractere

Methods: A 56 old hypertensive female patient, known for 10 years with HCM was admitted for advanced glo-bal heart failure symptoms. EKG showed sinus rhytm, ST descendent depression in V4-V6, DI-aVL, DII, DIII, aVF, Sokolow Lyon index =40 mm. TTE revea-led an HCM phenotype with a maximum unprovoked gradient in the left ventricular ejection tract (LVET) of 120 mmHg, degenerative and by systolic anterior movement 3rd degree mitral regurgitation, severe se-condary pulmonary hypertension (PAH). The coro-narography revealed coronary arteries without signifi-cant lesions. A high dose treatment with beta blockers, phenylalkylamine calcium blocker, diuretic, has been administred without significant improvements.

Results: Alcohol septal ablation therapy was propo-sed by alcohol ablation at the level of the first septal artery, after visualising the limitations of its teritory by myocardial ultrasound contrast. After the procedu-re, the patient has presented complete atrioventricu-lar heart block remitted after a few hours, with right bundle branch block. The echocardiography revealed the gradient reduction in LVET at 34 mmHg with the remission of PAH and heart failure symptoms. EKS monitoring for 72 hours according to the protocol did not revealed any pathological changes. One week after the procedure the patient has presented a cardiopulmonary arrest through ventricular asystole on a CHB, but successfully resurrected. A permanent two chamber cardiac pacemaker with favorable postoperative evolu-tion was implanted.

Conclusions: T he late recurrent complete atrioven-tricular block it’s a rare complication but a real threat after septal reduction therapy through alcohol ablati-on occuring outside of the standard electrocardiogra-phic follow-up. The case is important to mention and can serve as a starting point in prospective studies to establish some clear recommendations regarding the detection of the complications, patients follow-up and prevention of sudden cardiac death.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
ESC search engine
CODE: 379
CME Credits: 10 (Romanian College of Physicians)
This work is licensed under a Creative Commons Attribution 4.0 International License.