Predictors of Complete Heart Block After Alcohol Septal Ablation for Hypertrophic Cardiomyopathy and the Timing of Pacemaker Implantation

Catheter-based alcohol septal ablation has recently been introduced for the treatment of left ventricular outflow tract obstruction in hypertrophic obstructive cardiomyopathy. It is associated with various conduction disturbances and may lead to transient or persistent complete heart block (CHB). Electrocardiographic (ECG) changes and predictors of developing CHB and the timing of permanent pacemaker implantation have been variable among the different studies. Among 50 patients studied, we found that a new right bundle branch pattern was the most common new ECG change after septal ablation and that baseline left bundle branch block was strongly associated with the development of CHB (P = 0.004); 9 patients (18%) required permanent pacemaker implantation of whom 7 (78%) remained pacemaker dependent at 14 days with no delayed recovery of atrioventricular conduction. This favors an early pacemaker implantation strategy.