Radiofrequency septal reduction in symptomatic hypertrophic obstructive cardiomyopathy
Karl Crossen1, Marsha Jones1, Christopher Erikson1
1North Mississippi Medical Center, Tupelo, Mississippi.
Insights
Radiofrequency (RF) septal ablation is a safe, effective treatment for drug-resistant hypertrophic obstructive cardiomyopathy (HOCM). This nonsurgical option significantly reduces outflow tract obstruction and improves patient symptoms.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Ablation
Background:
- Alcohol septal ablation is the sole approved nonsurgical treatment for drug-resistant hypertrophic obstructive cardiomyopathy (HOCM).
- Radiofrequency (RF) ablation presents an alternative therapeutic approach for HOCM management.
Purpose of the Study:
- To evaluate the efficacy of irrigated RF ablation in reducing symptomatic outflow tract obstruction in adult HOCM patients.
Main Methods:
- 11 adult HOCM patients with significant outflow gradients (>50 mm Hg) despite medication underwent RF ablation.
- The hypertrophied interventricular septum was targeted using a 3-dimensional mapping system via transmitral or retrograde aortic approaches.
Main Results:
- 91% of patients experienced significant and persistent reduction in left ventricular outflow tract (LVOT) gradients.
- Mean LVOT gradients decreased by 85% at 12 months post-procedure (resting: 66.7 to 10.0 mm Hg; provocable: 136.2 to 20.0 mm Hg).
- New York Heart Association (NYHA) heart failure classification improved from Class 3.0 to a mean of 1.8.
Conclusions:
- RF septal ablation is a safe therapeutic option for HOCM.
- It effectively reduces LVOT gradients and improves symptoms, with efficacy comparable to alcohol septal ablation.
Background:
Alcohol septal ablation remains the only approved nonsurgical therapeutic alternative for patients with drug-resistant hypertrophic obstructive cardiomyopathy (HOCM). Radiofrequency (RF) ablation offers another option for treating HOCM.
Objective:
The purpose of this study was to determine whether irrigated RF ablation can reduce symptomatic outflow tract obstruction in adults with HOCM.
Methods:
Patients with symptomatic HOCM and an outflow gradient of >50 mm Hg despite medication were offered RF ablation. In 11 patients, the hypertrophied interventricular septum was localized on a 3-dimensional mapping system and ablated via a transmitral or retrograde aortic approach.
Results:
Ten of 11(91%) patients had a significant and persistent reduction in resting and provocable left ventricular outflow tract gradients. Mean resting gradients at 12 months postprocedure were reduced by 85% (66.7 mm Hg at baseline to 10.0 mm Hg at 12 months); mean provocable gradients were reduced by 85% from baseline (136.2 mm Hg at baseline to 20.0 mm Hg at 12 months). Functional New York Heart Association heart classification improved from class 3.0 ± 0.0 in all patients to class mean of 1.8 ± 0.8.
Conclusion:
RF septal ablation for the treatment of HOCM is a safe therapeutic option that allows for significant reduction in left ventricular outflow tract gradients, improvement in symptoms, and increase in efficacy rates comparable to reported rates for alcohol septal ablation.
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