Bipolar Percutaneous Endocardial Septal Radiofrequency Ablation (Bi-PESA): First-in-Human Application for
Aiju Tian1, Yuhe Jia1, Minghu Xiao2
1Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Combined bipolar and percutaneous endocardial septal radiofrequency ablation (Bi-PESA) offers a new treatment for drug-refractory hypertrophic obstructive cardiomyopathy (HOCM). This novel approach effectively reduced the left ventricular outflow tract gradient and improved patient symptoms.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Technology
Background:
- Drug-refractory hypertrophic obstructive cardiomyopathy (HOCM) presents treatment challenges for patients unsuitable for surgery or alcohol septal ablation.
- Conventional unipolar radiofrequency ablation offers limited relief due to shallow lesion depth.
- Bipolar radiofrequency ablation, effective for ventricular arrhythmias, has not been explored for HOCM.
Background:
Many patients with drug-refractory hypertrophic obstructive cardiomyopathy (HOCM) decline or are ineligible for surgical myectomy or alcohol septal ablation. Although conventional unipolar percutaneous endocardial septal radiofrequency ablation is a minimally invasive alternative, its limited lesion depth yields only modest left ventricular outflow tract gradient (LVOTG) relief. Bipolar radiofrequency catheter ablation creates deeper lesions in the treatment of ventricular arrhythmias; however, its role in HOCM remains unreported.
First-In-Human/Early Reports Summary:
We present the first in-human case of combined bipolar ablation and percutaneous endocardial septal radiofrequency ablation (Bi-PESA) in an older patient with drug-refractory HOCM. Ultimately, the patient experienced significant reduction in the LVOTG, translating to significant symptomatic improvement.
Discussion:
This case suggests Bi-PESA could be a novel, effective, and safe septal reduction option for patients with drug-refractory HOCM.
Novelty:
To our knowledge, this is the first-in-human report of Bi-PESA for HOCM to reduce LVOTG and improve symptoms.
Take-Home Message:
Bi-PESA may offer a feasible and potentially preferable alternative for patients with HOCM who decline or are ineligible for surgical myectomy or alcohol septal ablation.
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