AUTHOR=Liu Qiang , Qiu Hangyuan , Jiang Ruhong , Tang Xiaomei , Guo Wenpu , Zhou Kuangshi , Chen Qiufan , Sun Yaxun , Yu Lu , Chen Shiquan , Zhang Pei , Sheng Xia , Zhu Jun , Lin Jianwei , Cheng Hui , Wang Yunhe , Wang Bei , Yu Chan , Mao Yankai , Zhang Juhong , Zhang Zuwen , Zei Paul C. , Fu Guosheng , Jiang Chenyang 

TITLE=Selective Interventricular Septal Radiofrequency Ablation in Patients With Hypertrophic Obstructive Cardiomyopathy: Who Can Benefit?

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.743044

DOI=10.3389/fcvm.2021.743044

ISSN=2297-055X

ABSTRACT=<p><bold>Introduction:</bold> Septal mass reduction is beneficial for hypertrophic obstructive cardiomyopathy (HOCM) patients with severe left ventricular outflow (LVOT) gradient and symptoms, with surgical myectomy or alcohol septal ablation (ASA) currently recommended in selected patients. Radiofrequency (RF) ablation of hypertrophied septum has been published as a novel method to alleviate LVOT obstruction in small populations. This study aims to investigate factors influencing clinical outcomes of radiofrequency septum ablation.</p><p><bold>Methods and Results:</bold> In this study, 20 patients with HOCM who underwent endocardial ablation were included. Echocardiography and cardiac MRI (CMR) data was collected and analyzed pre- and (or) post- procedure. Nineteen patients underwent ablation successfully, while ablation was aborted in one patient with prior RBBB due to transient complete atrioventricular block (AVB). After 6 months of follow-up, NYHA heart functional class improved from III (2 - 3) to II (1 - 2) (<italic>p</italic> &lt; 0.001), and resting LVOT gradient was significantly reduced (87.6 ± 29.5 mmHg vs. 48.1 ± 29.7, <italic>p</italic> &lt; 0.001). LVOT gradient reduction was significantly higher in patients with limited basal septal hypertrophy (60.9 ± 8.3 vs. 27.9 ± 7.1, <italic>p</italic> = 0.01), shorter anterior mitral leaflet (56.1 ± 6.4 vs. 20.4 ± 5.0, <italic>p</italic> &lt; 0.01), and normally positioned papillary muscle (36.9 ± 7.1 vs. 75.0 ± 6.3, <italic>p</italic> &lt; 0.05).</p><p><bold>Conclusions:</bold> Endocardial septal ablation appears to be a safe and effective procedure for alleviating LVOT gradient in patients with HOCM, especially in those with limited basal septal hypertrophy, shorter anterior mitral leaflet, and normal positioned papillary muscle.</p>