Percutaneous Intramyocardial Septal Radiofrequency Ablation for Hypertrophic Cardiomyopathy With Residual Obstruction
Juan Zhang1, David H Hsi2, Shengjun Ta1
1Xijing Hypertrophic Cardiomyopathy Center, Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
Insights
Percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) is a feasible treatment for obstructive hypertrophic cardiomyopathy (oHCM) patients with persistent symptoms after alcohol septal ablation (ASA). This study shows PIMSRA effectively reduces left ventricular outflow tract obstruction and improves patient function.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Obstructive hypertrophic cardiomyopathy (oHCM) significantly impacts patient quality of life.
- Alcohol septal ablation (ASA) is a common treatment, but some patients experience residual symptoms and left ventricular outflow tract (LVOT) obstruction.
- The efficacy of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) in these cases is not well-established.
Purpose of the Study:
- To evaluate the feasibility and outcomes of PIMSRA in oHCM patients with residual LVOT obstruction post-ASA.
- To assess the safety and efficacy of PIMSRA as a repeat septal reduction therapy.
Main Methods:
- A retrospective analysis of 12 oHCM patients who underwent PIMSRA after failed ASA.
- Evaluation of clinical characteristics, imaging parameters, and follow-up outcomes.
- Assessment of New York Heart Association (NYHA) class, 6-minute walking distance, and LVOT gradients.
Main Results:
- All 12 patients successfully completed PIMSRA with no 30-day mortality or permanent pacemaker implantation.
- Significant improvement in NYHA class (3.0 to 2.0) and 6-minute walking distance (420m to 503m).
- 92% of patients achieved resting LVOT gradient < 50 mm Hg post-procedure, with sustained survival and no major adverse cardiac events during follow-up.
Conclusions:
- PIMSRA is a viable therapeutic option for oHCM patients with residual LVOT obstruction after ASA failure.
- PIMSRA demonstrates safety and efficacy in improving symptoms and functional capacity.
- Further large-scale studies are needed to confirm these findings.
Background:
Alcohol septal ablation (ASA) is a well established septal reduction therapy for patients with obstructive hypertrophic cardiomyopathy (oHCM). However, research has shown that some patients exhibit persistent severe symptoms and residual left ventricular outflow tract (LVOT) obstruction after ASA, thereby necessitating repeated septal reduction therapy. The feasibility of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) in oHCM patients with residual LVOT obstruction after ASA remains unknown.
Methods:
We analyzed 12 oHCM patients who underwent PIMSRA after ASA had failed at Xijing Hospital between January 2017 and August 2023, and evaluated their clinical characteristics, imaging parameters, and follow-up outcomes.
Results:
All 12 patients successfully underwent the PIMSRA procedure. Within the 30-day postprocedure period, no mortality or permanent pacemaker implantation was observed. The median follow-up duration was 12 (4.5-16.5) months. The New York Heart Association classification significantly improved from a median of class 3.0 (interquartile range [IQR], 1) to 2 (IQR, 1). Additionally, the 6-minute walking distance increased from 420 (IQR, 60.9) m to 503 (IQR, 83) m (P < 0.05). Post-PIMSRA, 11 patients (92%) had a resting LVOT residual gradient < 50 mm Hg, including 7 patients (58%) with a resting LVOT residual gradient < 30 mm Hg. One patient (8%) showed a provocable LVOT residual gradient > 50 mm Hg (170 mm Hg at baseline to 51 mm Hg at 6 months) but with significant symptomatic improvement. During the follow-up period, all patients survived, and no permanent pacemaker or implantable cardioverter defibrillator implantation occurred. Moreover, there were no incidences of aborted sudden cardiac death, sustained ventricular tachycardia, or acute systolic heart failure during the follow-up period.
Conclusions:
PIMSRA is a feasible therapeutic option for treating oHCM patients with residual LVOT obstruction after ASA has failed. However, further studies are required to validate the efficacy and safety of its application in a large study cohort.
Clinical Trial Registration:
NCT06496633.
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