Conduction Disturbances and Arrhythmia Risk After Septal Reduction Therapy with Alternative Agents: A Pilot Study with EVOH-DMSO and Systematic Review

Turk Kardiyol Dern Ars. 2023 Jan;51(1):40-49. doi: 10.5543/tkda.2022.69570.


Objective: Surgical septal myectomy and alcohol septal ablation are recommended treatment modalities for alleviating Left ventricular outflow tract (LVOT) gradient in obstructive HCM. Alcohol septal ablation offers advantages over surgery in many ways. However, it is associated with some life-threatening complications. For this purpose, our center used alternative agents for septal artery embolization. This study compared and evaluated conduction system defects and arrhythmia risk after EVOH-DMSO septal ablation with other alternative agents and alcohol septal ablation.

Methods: Twenty-five patients who received septal reduction therapy with EVOH-DMSO were analyzed retrospectively, and all non-alcoholic agent's septal ablation studies were systematically reviewed and compared.

Results: Twenty-five patients (52% female; mean age: 55.8 ± 17.1) with symptomatic obstructive HCM were enrolled. The Peak LVOT gradient was significantly reduced after the procedure (68 vs. 20 mmHg; P <0.001). During the 12-month follow-up, no mortality occurred. The complete atrioventricular block was noted in 2 (8%) patients. The incidence of right bundle branch block (RBBB) increased after the procedure (pre-procedural 2 patients (8%), post-procedural 9 patients (36%) P = 0.002). On ECG and Holter monitorization, no sustained ventricular tachyarrhythmia occurred during follow-up, and no change was found in the frequency of atrial fibrillation. We systematically compared EVOH-DMSO to other non-alcohol agents, and we found that EVOH-DMSO can cause conduction system problems more commonly than other non-alcohol agents.

Conclusion: EVOH-DMSO could cause conduction system problems more common than other non-alcohol agents but less than alcohol septal ablation.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Bundle-Branch Block / complications
  • Cardiac Conduction System Disease
  • Cardiomyopathy, Hypertrophic*
  • Dimethyl Sulfoxide*
  • Female
  • Heart Septum / surgery
  • Humans
  • Male
  • Middle Aged
  • Pilot Projects
  • Retrospective Studies
  • Treatment Outcome


  • Dimethyl Sulfoxide