Septal Preparation for TAVR Using Radiofrequency Catheters in Patients With LVOT Obstruction: 1-Year Follow-Up

Left ventricular outflow tract (LVOT) obstruction is frequent in hypertrophic cardiomyopathy. Septal radiofrequency ablation for treatment of LVOT obstruction, which is endocardial radiofrequency ablation of septal hypertrophy (ERASH), was previously performed in patients refractory to medical treatment with catheters used for cardiac arrhythmia ablation. Obstruction of the LVOT during transcatheter aortic valve replacement (TAVR) procedures may lead to suicide ventricle, the dire event of a sudden increase in the intraventricular gradient after valve obstruction alleviation. We present a 2-step procedure for septal preparation before TAVR in a series of 4 cases. All patients underwent ERASH before TAVR, which successfully reduced the LVOT gradient before implant (the longest waiting interval between procedures was 3 months and the shortest was 15 days). No patient underwent pacemaker or implantable cardioverter-defibrillator implant. To the best of our knowledge, this is the longest series of septal ablation before TAVR in patients who also presented with intraventricular LVOT obstruction.