Percutaneous endocardial septal radiofrequency ablation on syncope in patients with hypertrophic obstructive
Aiju Tian1, Tianjing Zhang1, Yuhe Jia1
1Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Insights
Percutaneous endocardial septal radiofrequency ablation (PESA) significantly reduced syncope in hypertrophic obstructive cardiomyopathy (HOCM) patients. Most patients experienced complete syncope alleviation or an 80% reduction, improving their quality of life.
Area of Science:
- Cardiology
- Interventional Cardiology
- Electrophysiology
Background:
- Syncope is a significant complication in patients with hypertrophic obstructive cardiomyopathy (HOCM).
- Percutaneous endocardial septal radiofrequency ablation (PESA) is an emerging treatment for HOCM symptoms.
- The impact of PESA on syncope in HOCM patients remains largely uncharacterized.
Purpose of the Study:
- To evaluate the efficacy of PESA in managing syncope in patients diagnosed with HOCM.
- To assess the impact of PESA on syncope frequency and severity in HOCM patients with significant left ventricular outflow tract gradients (LVOTG).
Main Methods:
- Nineteen HOCM patients with syncope and LVOTG >50 mmHg despite medical therapy were enrolled.
- PESA was performed using intracardiac echocardiography (ICE) and 3D electrophysiological mapping.
- Patients were followed for a median of 3 months (3-5.5 months).
Main Results:
- Syncope was completely resolved in 73.7% of patients and reduced by >=80% in 84.2% during follow-up.
- Mean NYHA functional class improved significantly from 2.2 to 1.7 (P=0.002).
- A trend towards decreased LVOTG and septal thickness was observed post-PESA.
Conclusions:
- PESA demonstrates significant effectiveness in reducing syncope episodes in HOCM patients.
- The procedure offers a promising therapeutic option for improving quality of life in this patient cohort.
Background:
Syncope is a serious consequence in patients with hypertrophic obstructive cardiomyopathy (HOCM). Percutaneous endocardial septal radiofrequency ablation (PESA) has emerged as a promising intervention to alleviate symptoms and enhance the quality of life for HOCM patients. However, little is known about the effects of PESA on syncope in HOCM. The authors aimed to study the effects of PESA on syncope in patients with HOCM.
Materials And Methods:
Nineteen patients with HOCM and syncope were enrolled. The left ventricular outflow tract gradient (LVOTG) of the patients was more than 50 mmHg despite medication. The participants underwent PESA under the guidance of intracardiac echocardiography (ICE) combined with a three-dimensional electrophysiological mapping system. The patients were followed for 3 (3-5.5) months.
Results:
The mean age of the patients was 54.8±13.7 years. Out of the 19 participants, 7 (37%) were females. During the follow-up, the syncope was completely alleviated in 14 patients (73.7%) or the syncope episodes were reduced greater than or equal to 80% in 16 patients (84.2%). The mean NYHA functional class significantly improved from 2.2±0.7 at baseline to 1.7±0.6 during follow-up (P=0.002). The LVOTG and septal thickness showed a decreasing trend from baseline to follow-up (LVOTG: P=0.083, septal thickness: P=0.086).
Conclusion:
The authors' investigation provides evidence supporting the effectiveness of PESA in reducing syncope episodes in patients with HOCM.
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