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Selective Interventricular Septal Radiofrequency Ablation in Patients With Hypertrophic Obstructive Cardiomyopathy:

Qiang Liu1, Hangyuan Qiu1, Ruhong Jiang1

  • 1Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

Frontiers in Cardiovascular Medicine
|December 6, 2021
PubMed

Insights

Radiofrequency septal ablation effectively reduces left ventricular outflow tract (LVOT) gradients in hypertrophic obstructive cardiomyopathy (HOCM) patients. This novel procedure improves heart function, particularly in patients with specific anatomical features.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Electrophysiology

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) presents a significant clinical challenge, often necessitating septal mass reduction.
  • Current treatments like surgical myectomy and alcohol septal ablation (ASA) have limitations.
  • Radiofrequency (RF) septal ablation is an emerging technique for managing LVOT obstruction.

Purpose of the Study:

  • To investigate the clinical outcomes of endocardial radiofrequency septal ablation in HOCM patients.
  • To identify patient-specific factors influencing the efficacy of RF septal ablation.
  • To assess the safety and effectiveness of RF septal ablation for LVOT gradient reduction.

Main Methods:

  • A cohort of 20 HOCM patients undergoing endocardial RF septal ablation was studied.
  • Pre- and post-procedure echocardiography and cardiac MRI (CMR) data were analyzed.
  • Clinical outcomes, including NYHA functional class and LVOT gradient, were assessed at 6-month follow-up.

Main Results:

  • Nineteen out of twenty patients successfully underwent the ablation procedure.
  • Significant improvement in NYHA heart functional class (III to II) and reduction in resting LVOT gradient (87.6 to 48.1 mmHg) were observed.
  • Greater LVOT gradient reduction was noted in patients with limited basal septal hypertrophy, shorter anterior mitral leaflet, and normally positioned papillary muscles.

Conclusions:

  • Endocardial septal ablation is a safe and effective treatment for HOCM patients with severe LVOT obstruction.
  • Favorable outcomes are particularly associated with specific anatomical characteristics: limited basal septal hypertrophy, shorter anterior mitral leaflet, and normal papillary muscle position.
  • RF septal ablation offers a promising alternative for septal mass reduction in selected HOCM patients.

Keywords:
anterior mitral leaflethypertrophic obstructive cardiomyopathymid-septal hypertrophypapillary muscle displacementradiofrequency septal ablation

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