Comparison of Percutaneous Endocardial Septal Radiofrequency Ablation With Alcohol Septal Ablation in Treating...

Alcohol septal ablation (ASA) and percutaneous endocardial septal radiofrequency ablation (PESA) are 2 minimally invasive interventions for treatment of hypertrophic obstructive cardiomyopathy (HOCM). However, studies comparing PESA and ASA remain scant.

In this study we analyzed patients with HOCM who underwent PESA or ASA at our hospital between January 2008 and December 2023. A total of 145 patients were enrolled, with 37 receiving PESA and 108 receiving ASA.

Compared with the ASA group, patients in the PESA group were older (P = 0.001), but suffered from less severe heart failure (P < 0.001). Patients in the ASA group were more likely to develop new bundle branch block (BBB) and stayed much longer in intensive care unit, but they incurred lower medical costs. During follow-up, there were no significant differences between the 2 groups in rates of repeat septal reduction therapy (SRT) and the composite endpoint of repeat SRT and rehospitalization. Both PESA and ASA significantly alleviated heart failure, septal hypertrophy, and left ventricular outflow tract (LVOT) obstruction. However, ASA led to greater reductions in New York Heart Association functional class (-1.4 ± 0.9 vs -0.7 ± 0.8, P < 0.001), septal thickness (-4.5 ± 4.1 vs -2.1 ± 4.1 mm, P = 0.012), and LVOT gradient (-51.1 ± 43.7 vs -23.0 ± 35.1 mm Hg, P = 0.004) compared with PESA.

Both ASA and PESA are viable strategies for septal reduction in HOCM. ASA seems to be more effective in achieving significant anatomic and functional improvements, whereas PESA is excellent for avoiding BBB.