Varying left ventricular outflow obstruction due to atrio-ventricular dyssynchrony in a patient with hypertrophic obstructive cardiomyopathy
2015
Abstract
Alcohol septal ablation (ASA) is an established non-surgical treatment of left ventricular outflow tract obstruction in patients with highly symptomatic hypertrophic obstructive cardiomyopathy (HOCM). The most frequent major complication associated with ASA is the mostly self-terminating complete heart block that occurs in 20-50% of patients and requires permanent pacemaker implantation in 9-20% of all ASA patients.
We report a case of varying left ventricular outflow gradient due to transient complete heart block in a patient after ASA for HOCM. The hemodynamic study illustrated the importance of atrial systole for left ventricular filling in patients with HOCM and the hemodynamic mechanisms of AV delay optimization by DDD pacing.