The Effect On The Efficacy Of Percutaneous Transluminal Septal Myocardial Ablation With Electrocardiographic Changes After PTSMA On Hypertrophic Obstructive Cardiomyopathy

Objectives: To observe a week changes of electrocardiographic afterpercutaneous transluminal septal myocardial ablation （PTSMA） on hypertrophicobstructive cardiomyopathy（HOCM）. To analyze the effect on the efficacy of PTSMAwith the ECG changes after the PTSMA.Methods: The retrospective study comprised of50patients with hypertrophicobstructive cardiomyopathy who were treated by percutaneous transluminal septalmyocardial ablation（absolute alcohol）from March2010to October2011in thePeople’s Hospital of Liaoning Province. To summarize the ECG changes andarrhythmia main types in a week after PTSMA. The patients who were treated byPTSMA were determined QT interval and QT-c, QRS duration, RV5+SV1. To observethe changes of left ventricular outflow tract pressure gradien （LVOTPG） andechocardiogram.Result: PTSMA was successfully performed in all the50patients. The studycontained28men and22women. The average age of the patients was （49.16±14.36）years. The average weight of the patients was（68±8.36）Kg. The number of havingfamily history patients was14（28%）. The number of smoking patients was10（12%）,the number of having drinking histories patients was2（4%）. The number of patientswith coronary heart disease was2（4%）, hypertension was7（14%）, diabetes mellituswas3（6%）. The number of hyperlipidemia patients was2（4%）, the number of patientswith atrial fibrillation was2（4%）, pulmonary hypertension was4（8%）. All the patientshave precardium systolic murmur and diastolic function insufficiency. Significant ECG changes, compared with the pre-procedure were: QRS duration from（94.60±13.29）msto（129.48±23.35）ms, P<0.05; QT interval from（395.84±38.97）ms to（446.92±48.42）ms, P<0.05; QT-c from（0.439±0.027）s to（0.466±0.045）s, P<0.05; RV5+SV1from（4.05±1.73）mV to（3.07±1.66）mV, P<0.05. Right bundle branch block from4（8%）patients to20（40%）patients. Left ventricle high tension from26（52%）patients to16（32%）patients. Left atrial enlargement from12（24%）patients to10（20%）patients.Small Q wave from14（28%） patients to22（44%） patients. The number of I°AVblock patients is2（4%）, it was no change after PTSMA. The number of ventricularpremature beat from5（10%）patients to8（16%）. The number of ST-T changes from24（48%）patients to28（56%）. All the patients were treated under the electrocardiogrammonitor for24～72hours after PTSMA. There was a case who had malignantarrhythmia during operation. No patients required permanent packmaker. No patientsdied. All the patients’ symptoms were improved. Significant UCG changes, comparedwith the pre-procedure were: LVIDd from （40.40±4.80）mm to （41.20±4.45）mm,P<0.05; LVIDs from （27.76±3.89）mm to（28.88±3.32）mm,P<0.05; ESV from（29.08±10.05）ml to（31.56±8.44）ml, P<0.05; EDV from （70.04±21.23）ml to（76.64±20.36）ml, P<0.05; LVOTPG from （85.40±33.43）mmHg to （24.04±15.45）mmHg, P<0.05.Conclusions:①PTSMA for HOCM induces significant ECG changes in mostpatients, including QRS prolongation, QT interval and QT-c interval prolongation,RV1+SV5descending and RBBB increasing. All the changes were associated withventricular septal myocardium necrosis which was caused by the operation. Thesechanges did not affect the efficacy of PTSMA.②PTSMA can significantly reduceLVOTPG and has a satisfactory short-term efficacy.③The LVIDd and LVIDsincreased, diastolic function were improved.④Clinical symptoms were significantlyimproved, without serious complications.