Polidocanol ablation in midventricular obstructive cardiomyopathy: novel approach and early outcomes

Midventricular obstructive hypertrophic cardiomyopathy (MVOHCM) poses significant challenges in diagnosis and treatment because of its unique anatomical and hemodynamic characteristics. Traditional interventions, such as alcohol septal ablation and surgical myectomy, are associated with complications and technical difficulties, prompting the search for alternative options. This study aimed to assess the safety, feasibility, and efficacy of polidocanol ablation in patients with symptomatic MVOHCM.

Polidocanol was utilized as a novel ablation agent to achieve septal reduction in a retrospective cohort of 11 patients. Procedural success was defined as a reduction of at least 50% in the midventricular gradient. Echocardiography, computed tomography, and cardiac magnetic resonance imaging guided the selection of patients and the planning of procedures.

The procedure significantly reduced midventricular gradients in all patients, with no reports of polidocanol leakage. The New York Heart Association (NYHA) functional class improved notably (P = .003), and interventricular septum thickness decreased from 22.73 ± 3.9 mm to 20.09 ± 3.7 mm (P = .022). Conduction defects occurred in 54.5% of patients, necessitating the placement of an implantable cardioverter-defibrillator in 27.3% of cases. There was no peri-procedural mortality. During a median follow-up period of 14 months, significant and persistent improvements in midventricular gradient and NYHA functional class were observed.

Polidocanol ablation was safe and effective as a minimally invasive option for managing MVOHCM, providing noteworthy procedural advantages. However, additional multicenter trials are needed to validate its use and establish standardized protocols.