The Risk of Ventricular Arrhythmias between Alcohol Septal Ablation and Septal Myectomy in Hypertrophic Cardiomyopathy: A Meta-Analysis on Septal Reduction Therapy
Background: Alcohol septal ablation (ASA) has been more commonly applied in medical refractory hypertrophic obstructive cardiomyopathy (HOCM) compared with septal myectomy (SM), however its potential to create a proarrhythmic substrate is increased. Methods: A systematic search was performed in PubM...
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| Format: | Article |
| Language: | English |
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IMR Press
2022-11-01
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| Series: | Reviews in Cardiovascular Medicine |
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| Online Access: | https://www.imrpress.com/journal/RCM/23/12/10.31083/j.rcm2312391 |
| _version_ | 1797975839625707520 |
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| author | Wei Tang Menghui Liu Jie Li Rongxuan Chang Chen Su Xiaoyu Zhang Lichun Wang |
| author_facet | Wei Tang Menghui Liu Jie Li Rongxuan Chang Chen Su Xiaoyu Zhang Lichun Wang |
| author_sort | Wei Tang |
| collection | DOAJ |
| description | Background: Alcohol septal ablation (ASA) has been more commonly applied in medical refractory hypertrophic obstructive cardiomyopathy (HOCM) compared with septal myectomy (SM), however its potential to create a proarrhythmic substrate is increased. Methods: A systematic search was performed in PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to October 2020. Fixed or random effects models were used to estimate the risk ratios (RR) for ventricular arrhythmia events or other outcomes between the SM and ASA cohorts. Results: Twenty studies with 8025 patients were included. Pool analysis showed that the incidence of ventricular tachycardia (VT)/ventricular fibrillation (VF), which included appropriate implantable cardioverter defibrillator (ICD) intervention, was significantly higher in the ASA cohort than that in the SM cohort (ASA vs SM: 10% (345/3312) vs 5% (161/3227) (RR = 1.98, 95% CI (confidence interval), 1.65–2.37; p < 0.00001, I2 = 0%). In both groups, more than 90% of VT/VF events occurred in the early phase (during the procedure, during hospitalization or within 30 days after the procedure) (ASA: 94.20%; SM: 94.41%). Further subgroup analysis also showed that the ASA group had a higher incidence of VT/VF in both the early phase (RR = 1.94, 95% CI, 1.61–2.33; p < 0.0001, I2 = 0%) and the late phase (RR = 2.80, 95% CI, 1.00–7.89; p = 0.05, I2 = 33%). Furthermore, although the risks of sudden cardiac death (SCD) were similar between the ASA and SM groups, a higher incidence of sudden cardiac arrest (SCA), which included SCD and resuscitated SCA, was observed in the ASA group (RR = 2.30, 95% CI, 1.35–3.94; p = 0.002, I2 = 0%). Conclusions: In patients with HOCM, those who received ASA showed a higher incidence of VF/VT and SCD combined with resuscitated SCA. The majority of VT/VF occurred in the early phase. |
| first_indexed | 2024-04-11T04:41:50Z |
| format | Article |
| id | doaj.art-f137c9d34a774c27a695c16656b280d5 |
| institution | Directory Open Access Journal |
| issn | 1530-6550 |
| language | English |
| last_indexed | 2024-04-11T04:41:50Z |
| publishDate | 2022-11-01 |
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| series | Reviews in Cardiovascular Medicine |
| spelling | doaj.art-f137c9d34a774c27a695c16656b280d52022-12-28T05:34:20ZengIMR PressReviews in Cardiovascular Medicine1530-65502022-11-01231239110.31083/j.rcm2312391S1530-6550(22)00741-4The Risk of Ventricular Arrhythmias between Alcohol Septal Ablation and Septal Myectomy in Hypertrophic Cardiomyopathy: A Meta-Analysis on Septal Reduction TherapyWei Tang0Menghui Liu1Jie Li2Rongxuan Chang3Chen Su4Xiaoyu Zhang5Lichun Wang6Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, 510080 Guangzhou, Guangdong, ChinaDepartment of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, 510080 Guangzhou, Guangdong, ChinaDepartment of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, 510080 Guangzhou, Guangdong, ChinaDepartment of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, 510080 Guangzhou, Guangdong, ChinaDepartment of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, 510080 Guangzhou, Guangdong, ChinaDepartment of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, 510080 Guangzhou, Guangdong, ChinaDepartment of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, 510080 Guangzhou, Guangdong, ChinaBackground: Alcohol septal ablation (ASA) has been more commonly applied in medical refractory hypertrophic obstructive cardiomyopathy (HOCM) compared with septal myectomy (SM), however its potential to create a proarrhythmic substrate is increased. Methods: A systematic search was performed in PubMed, EMBASE, Web of Science, and the Cochrane Library from inception to October 2020. Fixed or random effects models were used to estimate the risk ratios (RR) for ventricular arrhythmia events or other outcomes between the SM and ASA cohorts. Results: Twenty studies with 8025 patients were included. Pool analysis showed that the incidence of ventricular tachycardia (VT)/ventricular fibrillation (VF), which included appropriate implantable cardioverter defibrillator (ICD) intervention, was significantly higher in the ASA cohort than that in the SM cohort (ASA vs SM: 10% (345/3312) vs 5% (161/3227) (RR = 1.98, 95% CI (confidence interval), 1.65–2.37; p < 0.00001, I2 = 0%). In both groups, more than 90% of VT/VF events occurred in the early phase (during the procedure, during hospitalization or within 30 days after the procedure) (ASA: 94.20%; SM: 94.41%). Further subgroup analysis also showed that the ASA group had a higher incidence of VT/VF in both the early phase (RR = 1.94, 95% CI, 1.61–2.33; p < 0.0001, I2 = 0%) and the late phase (RR = 2.80, 95% CI, 1.00–7.89; p = 0.05, I2 = 33%). Furthermore, although the risks of sudden cardiac death (SCD) were similar between the ASA and SM groups, a higher incidence of sudden cardiac arrest (SCA), which included SCD and resuscitated SCA, was observed in the ASA group (RR = 2.30, 95% CI, 1.35–3.94; p = 0.002, I2 = 0%). Conclusions: In patients with HOCM, those who received ASA showed a higher incidence of VF/VT and SCD combined with resuscitated SCA. The majority of VT/VF occurred in the early phase.https://www.imrpress.com/journal/RCM/23/12/10.31083/j.rcm2312391hypertrophic cardiomyopathyseptal reduction therapyalcohol septal ablationseptal myectomyventricular arrhythmiasmeta-analysis |
| spellingShingle | Wei Tang Menghui Liu Jie Li Rongxuan Chang Chen Su Xiaoyu Zhang Lichun Wang The Risk of Ventricular Arrhythmias between Alcohol Septal Ablation and Septal Myectomy in Hypertrophic Cardiomyopathy: A Meta-Analysis on Septal Reduction Therapy Reviews in Cardiovascular Medicine hypertrophic cardiomyopathy septal reduction therapy alcohol septal ablation septal myectomy ventricular arrhythmias meta-analysis |
| title | The Risk of Ventricular Arrhythmias between Alcohol Septal Ablation and Septal Myectomy in Hypertrophic Cardiomyopathy: A Meta-Analysis on Septal Reduction Therapy |
| title_full | The Risk of Ventricular Arrhythmias between Alcohol Septal Ablation and Septal Myectomy in Hypertrophic Cardiomyopathy: A Meta-Analysis on Septal Reduction Therapy |
| title_fullStr | The Risk of Ventricular Arrhythmias between Alcohol Septal Ablation and Septal Myectomy in Hypertrophic Cardiomyopathy: A Meta-Analysis on Septal Reduction Therapy |
| title_full_unstemmed | The Risk of Ventricular Arrhythmias between Alcohol Septal Ablation and Septal Myectomy in Hypertrophic Cardiomyopathy: A Meta-Analysis on Septal Reduction Therapy |
| title_short | The Risk of Ventricular Arrhythmias between Alcohol Septal Ablation and Septal Myectomy in Hypertrophic Cardiomyopathy: A Meta-Analysis on Septal Reduction Therapy |
| title_sort | risk of ventricular arrhythmias between alcohol septal ablation and septal myectomy in hypertrophic cardiomyopathy a meta analysis on septal reduction therapy |
| topic | hypertrophic cardiomyopathy septal reduction therapy alcohol septal ablation septal myectomy ventricular arrhythmias meta-analysis |
| url | https://www.imrpress.com/journal/RCM/23/12/10.31083/j.rcm2312391 |
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