Abstract 18334: Electrocardiographic Alterations After Alcohol Septal Ablation Demonstrate 1-Year Lasting Reverse Remodeling Effect

Background: Alcohol septal ablation (ASA) is a treatment option in patients with hypertrophic obstructive cardiomyopathy (HOCM) and its refractory symptoms in spite of optimal medical therapy. The improvements of the related symptoms were derived from the acute reduction of left ventricular pressure gradieint (LVPG) and the chronic reverse remodeling. In many patients, the reverse remodeling effects have been observed for several months over. Methods: From 1998 through 2011, we performed 174 ASA procedures for drug-refractory symptomatic patients. We investigated clinical 2-years follow up and analyzed electrocardiogram (ECG) alternations from 1 month to 6months, 1 year and 2 years, to confirm the chronic effects. . Results: Out of 174 prosedures treated by ASA, excluding right bundle branch block (RBBB) and DDD or ICD therapy after ASA, total 23 patients in which we could complete 2-years follow-up were assigned to this study. Immediately after ASA, LVPG significantly improved from 68±39 to 25±28 mmHg (p<0.001), associated with symptomatic improvement (NYHA class from 2.5±0.6 to 1.2±0.5, p<0.001). From ECG findings, Sokolow-Lyon index reduced until 1 year later (5.0±0.4 to 4.8±0.4, p=0.005) and QRS duration significantly reduced until 6 months later (100±11 to 96±13msec, p=0.038). Conclusions: ASA improved not only the obstructive property but also the electrical abnormality in drug-refractory HOCM patients. The reduction of Sokolow-Lyon index and QRS duration suggested the reverse remodeling effects sustained 6 months to 1 year after ASA. Therefore, the effects should be monitored until 1 year from the ASA procedure.