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Alcohol-induced right bundle branch block is associated with a benign outcome in HOCM after alcohol septum ablation (ASA)

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Abstract

Introduction

Alcohol septum ablation (ASA) is a treatment option for hypertrophic obstructive cardiomyopathy (HOCM). We examined the impact of ASA-induced bundle branch block (BBB) on clinical and hemodynamic features.

Methods and results

We retrospectively analysed 98 HOCM patients with regard to ASA-induced BBB. Clinical examination was performed at baseline, early after ASA and at chronic follow-up (FU). ASA reduced left ventricular outflow tract gradient (LVOTG) during chronic FU (69.2 ± 41.6 pre vs. 31.8 ± 30.3 mmHg post ASA; p < 0.05) and interventricular septal diameter (21.7 ± 3.4 pre vs. 18.7 ± 5.0 mm post ASA; p < 0.05). ASA-induced early right BBB (RBBB) until discharge was observed in 44.9% and chronic RBBB at FU in 32.7%. Left BBB (LBBB) occurred in 13.3% early after ASA and in only 4.1% at chronic FU. Chronic RBBB was associated with more pronounced exercise-induced LVOTG reduction (102.1 ± 55.2 with vs. 73.6 ± 60.0 mmHg without; p < 0.05). 6-min-walk-test (6-MWT) and NYHA class were not affected by RBBB. LBBB had no influence on LVOTG, 6-MWT and symptoms. More ethanol was injected in patients with early RBBB (1.1 ± 0.4 vs. 0.8 ± 0.3 ml without; p < 0.05), who also showed higher mean CK release (827 ± 341 vs. 583 ± 279 U/l without; p < 0.05). Pacemaker implantation during FU was necessary in 11.5% of patients with early RBBB, 3.1% with chronic RBBB, 7.7% with early LBBB and 0% with chronic LBBB (p = n.s. for BBB vs. no BBB).

Conclusion

ASA-induced RBBB is associated with a higher volume of infused ethanol and higher maximum CK release. RBBB does not adversely affect the clinical outcome or need for pacemaker implantation but was associated with higher exercise-induced LVOTG reduction during chronic FU.

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Data availability

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Funding

This research was not supported by any funding.

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Authors and Affiliations

  1. Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld gemGmbH, Teutoburger Straße 50, 33604, Bielefeld, Germany

    Dennis Lawin, Thorsten Lawrenz, Kristin Radke & Christoph Stellbrink

  2. Faculty of Health, University of Witten/Herdecke, Alfred Herrenhausen Straße 50, 58455, Witten, Germany

    Thorsten Lawrenz

  3. Cardiology, Forum Salinum, Salinenstraße 4, 32105, Bad Salzuflen, Germany

    Andreas Wolff

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  1. Dennis Lawin
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Correspondence to Christoph Stellbrink.

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The authors declare that they have no conflicts of interest.

Ethics approval

The research project was approved by the ethics committee of the Westfälische Wilhelms-University Münster, Germany (file number 2020-780-f-S).

Consent to participate

Referring to the national ethical guidelines of Germany (§6 Gesundheitsdatenschutzgesetz NRW) the authors waived consent to participate due to retrospective study design and only intra-departmental data collection in our analysis. This was approved by the ethics committee of the Westfälische Wilhelms-University Münster, Germany (file number 2020-780-f-S).

Consent for publication

Referring to the national ethical guidelines of Germany (§6 Gesundheitsdatenschutzgesetz NRW) the authors waived consent to publication due to retrospective study design and only intra-departmental data collection in our analysis. This was approved by the ethics committee of the Westfälische Wilhelms-University Münster, Germany (file number 2020-780-f-S).

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Lawin, D., Lawrenz, T., Radke, K. et al. Alcohol-induced right bundle branch block is associated with a benign outcome in HOCM after alcohol septum ablation (ASA). Clin Res Cardiol 111, 175–185 (2022). https://doi.org/10.1007/s00392-021-01847-6

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  • DOI: https://doi.org/10.1007/s00392-021-01847-6

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