ABC | Volume 112, Nº4, April 2019

Original Article Retrospective Analysis of Risk Factors for Related Complications of Chemical Ablation on Hypertrophic Obstructive Cardiomyopathy Cheng-Yang Li 1 e Yun-Qi Shi 2 Department of Cardiology - Liaoning Provincial Jin Qiu Hospital, 1 Liaoning Province – China Department of Cardiology - Liaoning Provincial People’s Hospital, 2 Liaoning Province – China Mailing Address: Cheng-Yang Li • N°. 317 XIAONAN Street. 110016, Shenhe District, Shenyang City, Liaoning Province – China E-mail: chengyanglisvip@163.com Manuscript received March 23, 2018, revised manuscript July 19, 2018, accepted August 15, 2018 DOI: 10.5935/abc.20190060 Abstract Background: The analysis of risk factors for predicting related complications has not been reported to date. Objective: This study aims to investigate the risk factors of related complications of percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM) retrospectively. Method: Clinical data, and one-year follow-up results of patients withHOCM, who underwent PTSMA between January 2000 and July 2013 in the Department of Cardiology, Liaoning Province People’s Hospital, Liaoning Province, China, were retrospectively analyzed todetermine risk factors for operative complicationswithmultiple logistic regression analysis. All p values are two‑sided, with values of p < 0.05 being considered statistically significant. Results: Among 319 patients with HOCM, PTSMA was performed in 224 patients (120 males and 104 females, mean age was 48.20 ± 14.34 years old). The incidence of PTSMA procedure-related complications was 36.23% (66/224), which included three cardiac deaths, two cardiac shocks, one ST-segment elevated myocardial infarction, two ventricular fibrillations, 20 third‑degree atrioventricular (AV) blocks (four patients were implanted with a permanent pacemaker (PPM)), 32 complete right bundle branch blocks, two complete left bundle branch blocks, and four puncture-related complications. After multivariate logistic regression analysis, it was found that age, gender, coronary artery diseases, diabetes, heart rate, cardiac function on admission, the number of septal ablations, and the volume of alcohol were not independent risk factors correlated to the whole complications, except for hypertension (OR: 4.856; 95% CI: 1.732-13.609). Early experience appears to be associated with the occurrence of complications. Conclusion: Hypertension was an independent risk factor for PTSMA procedure-related complications. It might be much safer and more efficient if PTSMA procedures are restricted to experienced centers, according to the analysis results for the learning curve. (Arq Bras Cardiol. 2019; 112(4):432-438) Keywords: Cardiomyopathy, Hypertrophic/prevention and control; Myocardial, Percutaneous Transluminal Septal Myocardial Ablation (PTSMA); Ventricular Dysfunction Left/complications. Introduction Hypertrophic obstructive cardiomyopathy (HOCM) is defined as primary myocardial hypertrophy with dynamic left ventricular outflow tract (LVOT) obstruction and diastolic dysfunction of left ventricle (LV). HOCM, which induces symptoms of angina, dyspnea and syncope, is a genetically determined disorder caused by mutations in genes encoding sarcomeric contractile proteins. 1 Myectomy has been proven to be capable of improving short- and middle‑term survival in patients with HOCM with severe drug refractory symptoms. 2,3 With the development of techniques and equipment for percutaneous coronary intervention, percutaneous transluminal septal myocardial ablation (PTSMA) has become an alternative to myectomy with a decade history. 4,5 However, despite the advances in the judgment of indication, operating skill, optimal medical treatment and the management of complications, PTSMA‑related complications remain high during the perioperative period. The most common complication is right bundle branch block. The most significant complications include high-degree conduction block needing PPM, acute myocardial infarction, cardiac shock, cardiac death, puncture site complications. 6-8 Unfortunately, only predictors for long follow-up outcome have ever been analyzed. 7,9 The analysis of risk factors for predicting related complications have not been reported to date. In this report, we attempted to identify risk factors related to PTSMA procedure complications by conducting a retrospective review of 319 HOCM patients. Methods The study population comprised 319 patients with HOCM, who were referred to the Cardiology Department of Liaoning Provincial People’s Hospital of China, and considered septal reduction therapy with PTSMA between 432