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Radiofrequency ablation in patients with obstructive hypertrophic cardiomyopathy: A systematic review and
Camila Cássia Canzi1, Edivalde Ribeiro do Prado Júnior1, Antônio da Silva Menezes Júnior1,2
1Medicine School, Pontifical Catholic University of Goiás, Goiânia, GO, Brazil.
Insights
Radiofrequency ablation (RA) effectively treats obstructive hypertrophic cardiomyopathy (HCM) by reducing left ventricular outflow tract (LVOT) obstruction and improving symptoms. This minimally invasive procedure offers a valuable option for patients refractory to other therapies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Genetic Diseases
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic heart condition.
- Obstructive HCM can lead to left ventricular outflow tract (LVOT) obstruction.
- Limited studies exist on radiofrequency ablation (RA) for obstructive HCM.
Purpose of the Study:
- To evaluate the efficacy of radiofrequency ablation (RA) in patients with obstructive HCM.
- To assess the impact of RA on clinical and hemodynamic factors.
- To determine RA's effectiveness in refractory cases.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials and observational studies.
- Searched PubMed, Embase, and Science Direct databases.
- Included 6 studies with 304 patients (mean age 45 years).
- Assessed bias using ROBINS I tool; meta-analysis performed using STATA v.16.0.
Main Results:
- RA significantly reduced LVOT gradient at rest (58.78 mmHg) and with stimulation (70.38 mmHg).
- Improved New York Heart Association (NYHA) functional class (0.43 decrease).
- Reduced septal thickness by 4 mm.
Conclusions:
- Radiofrequency ablation (RA) demonstrates effectiveness in improving symptoms and hemodynamic factors in obstructive HCM.
- RA is a viable option for patients refractory to medical therapy or unsuitable for myectomy/alcohol septal ablation.
- Further randomized clinical trials are needed to solidify RA's role in HCM treatment.
Study Objective:
Hypertrophic cardiomyopathy (HCM) is a genetic disease that can cause left ventricular outflow tract (LVOT) obstruction. This study analyzed the efficacy of radiofrequency ablation (RA) in improving clinical and hemodynamic factors in patients receiving obstructive HCM refractory treatment. This evaluation was necessary because of the small number of studies on the effectiveness of this technique for obstructive HCM in the existing literature.
Design:
We used the PubMed, Embase, and Science Direct databases to identify randomized clinical trials and observational studies addressing the clinical and hemodynamic outcomes before and after RA in patients with HCM.
Participants:
We selected six articles published between 2011 and 2022, comprising 304 patients (mean age: 45 years).
Interventions:
We performed a bias assessment using the ROBINS I tool, and meta-analysis processing was performed using the STATA program (v.16.0).
Results:
The left ventricular outflow tract (LVOT) gradient at rest and with stimulation decreased by 58.78 mmHg (p = 0.001) and 70.38 mmHg (total effect Z = 21.62; p < 0.0001), respectively. Additionally, the New York Heart Association (NYHA) functional class decreased by 0.43 (p = 0.001), indicating symptomatic and hemodynamic improvements. Furthermore, we observed a significant reduction in septal thickness (by 4 mm; p = 0.001).
Conclusions:
RA improved the NYHA functional class and LVOT gradient at rest and with stimulation and reduced septal thickness. These results suggest that RA is effective in patients refractory to pharmacological therapy and unsuitable for alcohol septal ablation or myectomy. However, more studies, including randomized clinical trials, should be conducted to define the role of RA in interventional therapies.
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