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Radiofrequency ablation in patients with obstructive hypertrophic cardiomyopathy: An updated comprehensive review and
Antonio da Silva Menezes1,2, Murilo R Sanches1, Ernani de Oliveira Filho1
1Internal Medicine Department, Medicine Faculty, Federal University of Goiás, Goiás, Brazil.
Insights
Radiofrequency catheter ablation (RFCA) effectively treats hypertrophic obstructive cardiomyopathy (HOCM) by reducing the left ventricular outflow tract gradient and interventricular septum thickness. This procedure also improves the New York Heart Association (NYHA) class in patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Electrophysiology
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is a condition characterized by thickening of the heart muscle, leading to obstruction of blood flow.
- Surgical myectomy and alcohol septal ablation (ASA) are established treatments, but radiofrequency catheter ablation (RFCA) is an emerging therapeutic option.
- The efficacy and safety of RFCA for HOCM require further investigation due to limited research.
Conclusions:
- RFCA is an effective treatment for HOCM, demonstrating significant reductions in LVOT gradient and IVS thickness.
- The procedure is associated with improved functional capacity, as indicated by a reduced NYHA class.
- RFCA represents a viable therapeutic option for managing HOCM.
Background:
Radiofrequency catheter ablation (RFCA) has emerged as a therapeutic option for surgical myectomy and alcohol septal ablation (ASA) in patients with hypertrophic obstructive cardiomyopathy (HOCM), but its efficacy remains unclear.
Aim:
Due to limited research on RFCA for HCM, there is an ongoing attempt to assess its efficacy and safety.
Methods:
PubMed, Embase, and Scopus were systematically searched for studies assessing the efficacy outcomes for patients with HOCM who underwent RFCA. Mean differences (MDs) with 95% confidence intervals (CIs) were computed using a random-effects model and heterogeneity was assessed using I2 statistics.
Results:
We included 11 studies comprising 470 patients, of whom 34.6% were female. The mean patient age ranged from 43.7 to 60.7 years. During the follow-up after RFCA, there was a significant decrease in the left ventricular outflow tract (LVOT) gradient at rest (MD -60.25 mmHg; 95% CI [-70.53;-59.14 mmHg]; p < 0.01) and during stimulation (MD -83.56 mmHg; 95% CI [-100.36;-66.76 mmHg]; p < 0.01). Moreover, RFCA reduced interventricular septum (IVS) thickness (MD -3.61 mm; 95% CI [-5.64; -1.59 mm]; p = 0.01) and New York Heart Association (NYHA) class (MD -1.46; 95% CI [-1.69; -1.24]; p < 0.01).
Conclusions:
In patients with HOCM, RFCA was associated with an improved NYHA class, reduced IVS thickness, and decreased LVOT gradient at rest and with stimulation.
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