SPC365

Permanent Pacemaker implantation after Alcoholic Septal Ablation: long-term outcomes

Session: Posters (Sessão 4 - Écran 7) - Intervenção Cardíaca Coronária e Estrutural 2 - Foco na Doença Estrutural Não Valvular
Speaker: André Grazina

Congress: CPC 2022
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Pósters Electrónicos
FP Number: ---
Authors: André Grazina; Silvia Aguiar Rosa; António Fiarresga; Pedro Garcia Brás; Vera Ferreira; Isabel Cardoso; José Miguel Viegas; Ruben Ramos; Lídia de Sousa; Mário Oliveira; Duarte Cacela; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Introduction:</span></span></span></strong> <span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Patients with hypertrophic obstructive cardiomyopathy (HOCM) that remain symptomatic despite optimized medical therapy are often submitted to alcohol septal ablation (ASA). One of the most frequent complications is the complete hear block (CHB), requiring permanent pacemaker (PPM) in variable rates, up to 20% of the patients. The long-term impact of PPM implantation in these patients remains unclear.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Objectives:</span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black"> This study aims to evaluate the long-term pacemaker dependency in patients with PPM after ASA and to assess the long-term impact of PPM in these patients. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Methods:</span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black"> In a tertiary center, patients who underwent ASA were retrospectively analyzed. Patients with previous PPM or implantable cardio-defibrillator were excluded. The groups with and without PPM implantation after ASA were compared regarding baseline characteristics, procedure data and outcomes. In the group who implanted PPM, the long-term pacing rates were evaluated.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Results:</span></span></span></span></strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black"> Between 2009 and 2020, 109 patients underwent ASA. 97 patients were included in this analysis (68% female, mean age 65.2 years-old). 16 patients (16.5%) required PPM implantation for CHB. In those, no vascular access, pacemaker pocket or pulmonary parenchyma complications were noted. The baseline characteristics regarding comorbidities, symptoms, echocardiographic and electrocardiographic findings were identical in the two groups, with statistically significant differences in the mean age (70.6y/o in the PPM group versus 64.1y/o) and in the beta-blocker therapy rates previously to the intervention (56% in the PPM group versus 84%). Procedure-related data showed higher creatine kinase (CK) peaks in the PPM group (1692U/L versus 1243U/L, <em>p</em>0.05), without significant differences in the alcohol dose (2.1ml in both groups, <em>p</em>0.33). In the PPM group, the mean pacing rates at 1 month, 1 year and 2 years were 66.6&plusmn;38.0, 50.4&plusmn;44.1 and 50.8&plusmn;42.5, respectively, with 2 patients (12.5%) having 1-5% pacing and none having pacing &lt;1% at 2 years. In the group without PPM, 5 patients (6.2%) required posteriorly PPM implantation during the follow-up. There were no statistically significant differences in the two groups regarding in-hospital mortality, 1 year mortality or 1 year re-hospitalization. Despite a lower mean follow-up period in the PPM group (2.3&plusmn;1.5 years versus 3.5&plusmn;2.2 years, <em>p</em>0.05), there were no differences in the groups regarding all-cause mortality, cardiac cause mortality and all-cause re-hospitalization, with a statistical tendency to a lower cardiac cause re-hospitalization in the PPM group (19% versus 43%, <em>p</em>0.07).</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black">Conclusions:</span></span></span></span></strong><span style="font-size:12.0pt"><span style="background-color:white"><span style="font-family:&quot;Arial Narrow&quot;,sans-serif"><span style="color:black"> The registered pacing rates shows that all devices were adequately implanted. The long-term impact analysis suggests that the outcomes in patients who implant PPM after ASA are non-inferior to those who do not, with a tendency to reduce the re-hospitalizations for cardiac causes. </span></span></span></span></span></span></p>