Predicting complete heart block after alcohol septal ablation for hypertrophic cardiomyopathy using a risk stratification model and clinical tool
Background Alcohol septal ablation (ASA) is a proven method of septal reduction for patients with drug refractory, symptomatic hypertrophic obstructive cardiomyopathy (HOCM). This procedure is associated with a 6.5–11% risk of complete heart block (CHB). Objective The aim of this study is to determi...
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| Published in: | Catheterization and cardiovascular interventions Vol. 98; no. 2; pp. 393 - 400 |
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| Main Authors: | , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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Hoboken, USA
John Wiley & Sons, Inc
01.08.2021
Wiley Subscription Services, Inc |
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| ISSN: | 1522-1946, 1522-726X, 1522-726X |
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| Abstract | Background
Alcohol septal ablation (ASA) is a proven method of septal reduction for patients with drug refractory, symptomatic hypertrophic obstructive cardiomyopathy (HOCM). This procedure is associated with a 6.5–11% risk of complete heart block (CHB).
Objective
The aim of this study is to determine factors that predict CHB and to develop a clinical tool for risk stratification of patients.
Methods
Patients were enrolled into an ongoing ASA study. A total of 636 patient procedures were included, 527 of whom were used in the development of the prediction tool, and 109 of whom were used for independent validation. Multivariate analysis was performed with odds ratios used to develop the clinical prediction tool. This was then internally and externally validated.
Results
Of the 527 in the prediction cohort, 46 developed CHB. The predictors of CHB were age ≥50 years, pre‐ASA left bundle branch block (LBBB), transient procedural high‐grade block, post‐ASA PR prolongation ≥68 ms, and new bifascicular block. An 11‐point clinical prediction tool was developed to classify these factors. Internal validation using a receiver operating characteristic curve revealed an area under the curve of 0.88 for the clinical prediction tool. External validation using 109 contemporary patients revealed a 98% negative predictive value, 24% positive predictive value, 75% sensitivity, and 81% specificity in high‐risk patients.
Conclusion
Among patients undergoing ASA, the risk of CHB can be predicted with easily obtained clinical and electrocardiographic factors. This clinical prediction tool allows identification of high‐risk patients who may benefit from additional monitoring and therapy. |
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| AbstractList | Alcohol septal ablation (ASA) is a proven method of septal reduction for patients with drug refractory, symptomatic hypertrophic obstructive cardiomyopathy (HOCM). This procedure is associated with a 6.5-11% risk of complete heart block (CHB).BACKGROUNDAlcohol septal ablation (ASA) is a proven method of septal reduction for patients with drug refractory, symptomatic hypertrophic obstructive cardiomyopathy (HOCM). This procedure is associated with a 6.5-11% risk of complete heart block (CHB).The aim of this study is to determine factors that predict CHB and to develop a clinical tool for risk stratification of patients.OBJECTIVEThe aim of this study is to determine factors that predict CHB and to develop a clinical tool for risk stratification of patients.Patients were enrolled into an ongoing ASA study. A total of 636 patient procedures were included, 527 of whom were used in the development of the prediction tool, and 109 of whom were used for independent validation. Multivariate analysis was performed with odds ratios used to develop the clinical prediction tool. This was then internally and externally validated.METHODSPatients were enrolled into an ongoing ASA study. A total of 636 patient procedures were included, 527 of whom were used in the development of the prediction tool, and 109 of whom were used for independent validation. Multivariate analysis was performed with odds ratios used to develop the clinical prediction tool. This was then internally and externally validated.Of the 527 in the prediction cohort, 46 developed CHB. The predictors of CHB were age ≥50 years, pre-ASA left bundle branch block (LBBB), transient procedural high-grade block, post-ASA PR prolongation ≥68 ms, and new bifascicular block. An 11-point clinical prediction tool was developed to classify these factors. Internal validation using a receiver operating characteristic curve revealed an area under the curve of 0.88 for the clinical prediction tool. External validation using 109 contemporary patients revealed a 98% negative predictive value, 24% positive predictive value, 75% sensitivity, and 81% specificity in high-risk patients.RESULTSOf the 527 in the prediction cohort, 46 developed CHB. The predictors of CHB were age ≥50 years, pre-ASA left bundle branch block (LBBB), transient procedural high-grade block, post-ASA PR prolongation ≥68 ms, and new bifascicular block. An 11-point clinical prediction tool was developed to classify these factors. Internal validation using a receiver operating characteristic curve revealed an area under the curve of 0.88 for the clinical prediction tool. External validation using 109 contemporary patients revealed a 98% negative predictive value, 24% positive predictive value, 75% sensitivity, and 81% specificity in high-risk patients.Among patients undergoing ASA, the risk of CHB can be predicted with easily obtained clinical and electrocardiographic factors. This clinical prediction tool allows identification of high-risk patients who may benefit from additional monitoring and therapy.CONCLUSIONAmong patients undergoing ASA, the risk of CHB can be predicted with easily obtained clinical and electrocardiographic factors. This clinical prediction tool allows identification of high-risk patients who may benefit from additional monitoring and therapy. BackgroundAlcohol septal ablation (ASA) is a proven method of septal reduction for patients with drug refractory, symptomatic hypertrophic obstructive cardiomyopathy (HOCM). This procedure is associated with a 6.5–11% risk of complete heart block (CHB).ObjectiveThe aim of this study is to determine factors that predict CHB and to develop a clinical tool for risk stratification of patients.MethodsPatients were enrolled into an ongoing ASA study. A total of 636 patient procedures were included, 527 of whom were used in the development of the prediction tool, and 109 of whom were used for independent validation. Multivariate analysis was performed with odds ratios used to develop the clinical prediction tool. This was then internally and externally validated.ResultsOf the 527 in the prediction cohort, 46 developed CHB. The predictors of CHB were age ≥50 years, pre‐ASA left bundle branch block (LBBB), transient procedural high‐grade block, post‐ASA PR prolongation ≥68 ms, and new bifascicular block. An 11‐point clinical prediction tool was developed to classify these factors. Internal validation using a receiver operating characteristic curve revealed an area under the curve of 0.88 for the clinical prediction tool. External validation using 109 contemporary patients revealed a 98% negative predictive value, 24% positive predictive value, 75% sensitivity, and 81% specificity in high‐risk patients.ConclusionAmong patients undergoing ASA, the risk of CHB can be predicted with easily obtained clinical and electrocardiographic factors. This clinical prediction tool allows identification of high‐risk patients who may benefit from additional monitoring and therapy. Alcohol septal ablation (ASA) is a proven method of septal reduction for patients with drug refractory, symptomatic hypertrophic obstructive cardiomyopathy (HOCM). This procedure is associated with a 6.5-11% risk of complete heart block (CHB). The aim of this study is to determine factors that predict CHB and to develop a clinical tool for risk stratification of patients. Patients were enrolled into an ongoing ASA study. A total of 636 patient procedures were included, 527 of whom were used in the development of the prediction tool, and 109 of whom were used for independent validation. Multivariate analysis was performed with odds ratios used to develop the clinical prediction tool. This was then internally and externally validated. Of the 527 in the prediction cohort, 46 developed CHB. The predictors of CHB were age ≥50 years, pre-ASA left bundle branch block (LBBB), transient procedural high-grade block, post-ASA PR prolongation ≥68 ms, and new bifascicular block. An 11-point clinical prediction tool was developed to classify these factors. Internal validation using a receiver operating characteristic curve revealed an area under the curve of 0.88 for the clinical prediction tool. External validation using 109 contemporary patients revealed a 98% negative predictive value, 24% positive predictive value, 75% sensitivity, and 81% specificity in high-risk patients. Among patients undergoing ASA, the risk of CHB can be predicted with easily obtained clinical and electrocardiographic factors. This clinical prediction tool allows identification of high-risk patients who may benefit from additional monitoring and therapy. Background Alcohol septal ablation (ASA) is a proven method of septal reduction for patients with drug refractory, symptomatic hypertrophic obstructive cardiomyopathy (HOCM). This procedure is associated with a 6.5–11% risk of complete heart block (CHB). Objective The aim of this study is to determine factors that predict CHB and to develop a clinical tool for risk stratification of patients. Methods Patients were enrolled into an ongoing ASA study. A total of 636 patient procedures were included, 527 of whom were used in the development of the prediction tool, and 109 of whom were used for independent validation. Multivariate analysis was performed with odds ratios used to develop the clinical prediction tool. This was then internally and externally validated. Results Of the 527 in the prediction cohort, 46 developed CHB. The predictors of CHB were age ≥50 years, pre‐ASA left bundle branch block (LBBB), transient procedural high‐grade block, post‐ASA PR prolongation ≥68 ms, and new bifascicular block. An 11‐point clinical prediction tool was developed to classify these factors. Internal validation using a receiver operating characteristic curve revealed an area under the curve of 0.88 for the clinical prediction tool. External validation using 109 contemporary patients revealed a 98% negative predictive value, 24% positive predictive value, 75% sensitivity, and 81% specificity in high‐risk patients. Conclusion Among patients undergoing ASA, the risk of CHB can be predicted with easily obtained clinical and electrocardiographic factors. This clinical prediction tool allows identification of high‐risk patients who may benefit from additional monitoring and therapy. |
| Author | Nielsen, Christopher D. Karimianpour, Ahmadreza Shaji, Shawn Leaphart, Davis Heizer, Justin Rier, Jeremy D. Gold, Michael R. Ramakrishnan, Viswanathan Fernandes, Valerian L. |
| Author_xml | – sequence: 1 givenname: Ahmadreza orcidid: 0000-0002-8450-8308 surname: Karimianpour fullname: Karimianpour, Ahmadreza organization: Medical University of South Carolina – sequence: 2 givenname: Justin surname: Heizer fullname: Heizer, Justin organization: Virginia Commonwealth University – sequence: 3 givenname: Davis surname: Leaphart fullname: Leaphart, Davis organization: Medical University of South Carolina – sequence: 4 givenname: Jeremy D. surname: Rier fullname: Rier, Jeremy D. organization: Medical University of South Carolina – sequence: 5 givenname: Shawn surname: Shaji fullname: Shaji, Shawn organization: Medical University of South Carolina – sequence: 6 givenname: Viswanathan surname: Ramakrishnan fullname: Ramakrishnan, Viswanathan organization: Medical University of South Carolina – sequence: 7 givenname: Christopher D. surname: Nielsen fullname: Nielsen, Christopher D. organization: Medical University of South Carolina – sequence: 8 givenname: Valerian L. surname: Fernandes fullname: Fernandes, Valerian L. organization: Medical University of South Carolina – sequence: 9 givenname: Michael R. surname: Gold fullname: Gold, Michael R. email: goldmr@musc.edu organization: Medical University of South Carolina |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33491861$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1016_j_hrthm_2023_12_002 crossref_primary_10_1002_ccd_29849 crossref_primary_10_1007_s00392_025_02752_y crossref_primary_10_1007_s10840_023_01532_w crossref_primary_10_1016_j_cjca_2023_12_001 crossref_primary_10_1007_s42979_024_02701_y crossref_primary_10_1016_j_carrev_2023_01_013 crossref_primary_10_3389_fcvm_2021_695247 |
| Cites_doi | 10.1001/jamacardio.2015.0354 10.1161/01.CIR.98.17.1750 10.1016/j.jcin.2008.07.005 10.1053/euhj.1999.1520 10.1161/01.CIR.95.8.2075 10.1016/j.jtcvs.2004.08.047 10.1111/j.1540-8183.2000.tb00282.x 10.1016/j.ijcard.2006.07.179 10.1016/j.jacc.2011.06.011 10.1161/CIRCINTERVENTIONS.119.008540 10.1016/S0735-1097(03)00623-5 10.1016/j.amjcard.2010.01.367 10.1007/s00392-004-1028-6 10.3389/fpubh.2017.00307 10.1016/j.jacc.2007.11.071 10.1161/01.CIR.0000117089.99918.5A 10.1016/S0140-6736(95)91267-3 10.1093/eurheartj/ehr013 10.1016/j.jacc.2017.02.080 10.2169/internalmedicine.2563-18 10.1016/j.jacc.2015.01.019 10.1111/j.1540-8183.2007.00220.x 10.1161/CIRCHEARTFAILURE.108.768119 10.1016/j.amjcard.2005.08.032 10.1016/j.jacc.2007.02.056 10.1007/s00392-003-0878-7 |
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| Keywords | complete heart block hypertrophic obstructive cardiomyopathy alcohol septal ablation |
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Alcohol septal ablation (ASA) is a proven method of septal reduction for patients with drug refractory, symptomatic hypertrophic obstructive... Alcohol septal ablation (ASA) is a proven method of septal reduction for patients with drug refractory, symptomatic hypertrophic obstructive cardiomyopathy... BackgroundAlcohol septal ablation (ASA) is a proven method of septal reduction for patients with drug refractory, symptomatic hypertrophic obstructive... |
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| SubjectTerms | Ablation alcohol septal ablation Cardiomyopathy complete heart block hypertrophic obstructive cardiomyopathy Multivariate analysis Patients Predictions |
| Title | Predicting complete heart block after alcohol septal ablation for hypertrophic cardiomyopathy using a risk stratification model and clinical tool |
| URI | https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fccd.29478 https://www.ncbi.nlm.nih.gov/pubmed/33491861 https://www.proquest.com/docview/2559370696 https://www.proquest.com/docview/2480753647 |
| Volume | 98 |
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