Conduction Disturbances and Arrhythmia Risk After Septal Reduction Therapy with Alternative Agents: A Pilot Study with EVOH-DMSO and Systematic Review

Objective: Surgical septal myectomy and alcohol septal ablation are recommended treatment modalities for alleviating Left ventricular outflow tract (LVOT) gradient in obstructive HCM. Alcohol septal ablation offers advantages over surgery in many ways. However, it is associated with some life-threatening complications. For this purpose, our center used alternative agents for septal artery embolization. This study compared and evaluated conduction system defects and arrhythmia risk after EVOH-DMSO septal ablation with other alternative agents and alco-hol septal ablation. Methods: Twenty-five patients who received septal reduction therapy with EVOH-DMSO were analyzed retrospectively, and all non-alcoholic agent's septal ablation studies were systemat-ically reviewed and compared. Results: Twenty-five patients (52% female; mean age: 55.8 +/- 17.1) with symptomatic ob-structive HCM were enrolled. The Peak LVOT gradient was significantly reduced after the pro-cedure (68 vs. 20 mmHg; P <0.001). During the 12-month follow-up, no mortality occurred. The complete atrioventricular block was noted in 2 (8%) patients. The incidence of right bundle branch block (RBBB) increased after the procedure (pre-procedural 2 patients (8%), post-procedural 9 patients (36%) P = 0.002). On ECG and Holter monitorization, no sustained ventricular tachyarrhythmia occurred during follow-up, and no change was found in the fre-quency of atrial fibrillation. We systematically compared EVOH-DMSO to other non-alcohol agents, and we found that EVOH-DMSO can cause conduction system problems more com-monly than other non-alcohol agents. Conclusion: EVOH-DMSO could cause conduction system problems more common than other non-alcohol agents but less than alcohol septal ablation.

Automated summary

This study compared and evaluated the conduction system defects and arrhythmia risk after EVOH-DMSO septal ablation with other non-alcohol agents and alcohol septal ablation. The results showed that although EVOH-DMSO can cause conduction system problems more commonly than other non-alcohol agents, it is less common than alcohol septal ablation.