Endocardial Radiofrequency Ablation for Hypertrophic Obstructive Cardiomyopathy

Abstract

ERASH is a new therapeutic option in the treatment of HOCM, allowing significant and sustained reduction of the LVOT gradient as well as symptomatic improvement with acceptable safety by inducing a discrete septal contraction disorder. It may be suitable for patients not amenable to transcoronary ablation of septal hypertrophy or myectomy.

Percutaneous Radiofrequency Septal Reduction for Hypertrophic Obstructive Cardiomyopathy in Children

“…Based on these studies and on clinical data, we aimed to achieve catheter tip temperatures between 40°C and 50°C, with a nominal power setting of 60 W. The mechanism of RF effect is most likely tissue desiccation, followed by muscle atrophy. Lawrenz et al (39) recently demonstrated the beneficial effect of RF ablation in adult patients with LVOTO. They suggested that the mechanism of benefit might be the result of a local movement disorder, preventing the treated segment of septum from contracting effectively.…”

“…In Ͼ50% of their patients, they performed RF ablation from the right ventricle (39). Given that the septal thickness in some patients may exceed 30 mm, it is unclear how transcatheter lesions on the right ventricular septum might create adequate relief of LVOTO.…”

Non-surgical septal reduction therapy in hypertrophic cardiomyopathy

“…Lawrenz et al 85 reported the first series of 19 adults, 8 of whom had ineffective ASA due to inappropriate coronary anatomy. Ablation was performed from the RV cavity in 10 patients and LV cavity in 9.…”

How Can we Improve Non-Surgical Septal Reduction for Hypertrophic Obstructive Cardiomyopathy?

“…Radiofrequency ablation [35,36] A catheter is placed at the bundle of His. Radiofrequency ablation is performed with an irrigated-tip ablation catheter…”