Prognostic Significance of Initial r-Wave in Leads V1 and aVR Before PTSMA in Patients with Hypertrophic Obstructive Cardiomyopathy

OBJECTIVE: Percutaneous transluminal septal myocardial ablation (PTSMA) is one of the septal reduction therapies without all satisfactory results in hypertrophic obstructive cardiomyopathy (HOCM) patients. Initial r-wave in leads V1 and aVR on the surface electrocardiography is the sign of ventricular septal base depolarization. Whether the initial r-wave in leads V1 and aVR is predictive of good mid-term response to PTSMA in patients with HOCM remains unknown. DESIGN, SETTINGS, AND PARTICIPANTS: Among 546 consecutive patients evaluated in Fuwai Hospital (Beijing, China), we selected HOCM patients who underwent PTSMA. During the 3-year follow-up after PTSMA, primary outcomes included death, surgical myectomy, syncope, and NYHA classification III/IV. RESULTS: At last, 85 patients were selected, and were assigned to 3 groups based on the presence of initial r-wave in leads V1 and aVR. Through multivariable Cox and Kaplan–Meier method, patients with initial r-wave in both leads V1 and aVR were independently associated with a decreased risk of primary outcomes (HR: 0.112; 95% CI: 0.024 to 0.518; p = 0.005) during 3-years’ follow-up. CONCLUSION: The results suggest that the presence of initial r-wave in both leads V1 and aVR on the surface 12-lead ECG is highly predictive of good mid-term response to PTSMA in patients with HOCM.