Radiofrequency septal reduction in symptomatic hypertrophic obstructive cardiomyopathy

Crossen, Karl J.; Jones, Marsha; Erikson, Christopher

doi:10.1016/j.hrthm.2016.04.018

Cited by 35 publications

(48 citation statements)

References 14 publications

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“…After removing duplicates, 1624 studies remained. Eight studies published between 2005 and 2019 (including a conference abstract) were included in this analysis according to the inclusion and exclusion criteria (Figure ). Ninety‐one patients underwent radiofrequency septal ablation for HOCM with a mean follow‐up of 11.6 months (range, 1.3‐48 months).…”

Section: Resultsmentioning

confidence: 99%

“…All studies were assessed by NOS in which two studies received seven scores, four studies received eight scores and two studies received nine scores. It represented moderate to high methodological quality.…”

Section: Resultsmentioning

confidence: 99%

“…In this review, we found that the incidence of permanent pacemaker implantation was 8.8%, which was not higher than that of ASA. However, clinical studies of radiofrequency ablation conducted in recent years reported a lower incidence of pacemaker dependency because of use of the electroanatomical mapping system . The His conduction tissue, left bundle, and left anterior and posterior fascicles were directly mapped during radiofrequency ablation, which helped to preserve atrioventricular conduction and was a potential benefit of radiofrequency ablation.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of radiofrequency ablation for hypertrophic obstructive cardiomyopathy: A systematic review and meta‐analysis

Yang

Xue

et al. 2020

Clinical Cardiology

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Background: Although radiofrequency ablation is widely used in the treatment of arrhythmias, its role in septal reduction therapy of hypertrophic obstructive cardiomyopathy (HOCM) is unclear. This meta-analysis aimed to assess the efficacy and safety of radiofrequency septal ablation for HOCM.Hypothesis: Radiofrequency septal ablation is effective and safe for relieving obstruction and improving exercise capacity in patients with HOCM.Methods: A systematic review of eligible studies that reported outcomes of patients with HOCM who underwent radiofrequency septal ablation was performed using PubMed, Embase, Cochrane, ProQuest, Scopus, ScienceDirect, and Web of Science database. Pooled estimates were calculated using random-effects meta-analysis.Methodological quality was assessed using the Newcastle-Ottawa scale. Publication bias and sensitivity analyses were also performed.Results: Eight studies with 91 patients (mean follow-up 11.6 months) were included.The left ventricular outflow tract (LVOT) gradient at rest decreased significantly after radiofrequency septal ablation (pooled reduction: −58.8 mmHg; 95% confidence interval [CI] −64.3 to −53.5). A reduction was also found in the provoked LVOT gradient with a pooled reduction of −97.6 mmHg (95% CI: −124.4 to −87.1). An improvement of the New York Heart Association classification (mean: −1.4; 95% CI: −1.6 to −1.2) was found during follow-up. The change in septal thickness was minimal and not statistically significant. Two procedure-related deaths were documented, and complete heart block occurred in eight patients.Conclusions: Radiofrequency septal ablation is effective and safe for relieving LVOT obstruction and improving exercise capacity in patients with HOCM. K E Y W O R D S hypertrophic obstructive cardiomyopathy, meta-analysis, radiofrequency ablation, septal reduction therapy Haonan Yang and Yuan Yang contributed equally to this work.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of radiofrequency ablation for hypertrophic obstructive cardiomyopathy: A systematic review and meta‐analysis

Yang

Xue

et al. 2020

Clinical Cardiology

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“…Several small series have since been published ( n = 74) . Septal reduction remains modest (1–2 mm compared to ∼5–6 mm with ASA), likely due to the limited subendocardial delivery of energy and lesion formation.…”

Section: Novel Procedural Techniques For Hypertrophic Cardiomyopathymentioning

confidence: 99%

“…Several small series have since been published (n = 74). [90][91][92][93] Septal reduction remains modest (1-2 mm compared to ∼5-6 mm with ASA), likely due to the limited subendocardial delivery of energy and lesion formation. Two procedure-related deaths were reported due to retroperitoneal bleed and paradoxical increase in LVOT gradient (due to tissue oedema), as well as an 11% rate of CHB.…”

Section: Radiofrequency Ablationmentioning

confidence: 99%

Hypertrophic cardiomyopathy: the future of treatment

Tuohy

Kaul

Song

et al. 2020

European J of Heart Fail

119

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Hypertrophic cardiomyopathy (HCM) is a heterogeneous genetic disorder most often caused by sarcomeric mutations resulting in left ventricular hypertrophy, fibrosis, hypercontractility, and reduced compliance. It is the most common inherited monogenic cardiac condition, affecting 0.2% of the population. Whereas currently available therapies for HCM have been effective in reducing morbidity, there remain important unmet needs in the treatment of both the obstructive and non‐obstructive phenotypes. Novel pharmacotherapies directly target the molecular underpinnings of HCM, while innovative procedural techniques may soon offer minimally‐invasive alternatives to current septal reduction therapy. With the advent of embryonic gene editing, there now exists the potential to correct underlying genetic mutations that may result in disease. This article details the recent developments in the treatment of HCM including pharmacotherapy, septal reduction procedures, mitral valve manipulation, and gene‐based therapies.

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Percutaneous Intramyocardial Septal Radiofrequency Ablation in Patients With Drug-Refractory Hypertrophic Obstructive Cardiomyopathy

Zhou

Hahn

et al. 2022

JAMA Cardiol

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IMPORTANCEPatients with hypertrophic obstructive cardiomyopathy (HOCM) and drug-refractory symptoms and outflow gradients have limited nonsurgical treatment options. The feasibility of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) has been reported previously; however, procedural and medium-term outcomes are unknown.OBJECTIVE To describe the safety and medium-term outcomes of PIMSRA in a large patient cohort with drug-refractory HOCM. DESIGN, SETTING, AND PARTICIPANTSThis was a single-arm, open-label study of PIMSRA in patients with drug-refractory HOCM. Patients presenting to the Xijing Hospital in Xi'an, China, between October 2016 to June 2020 with hypertrophic cardiomyopathy. Of 1314 patients presenting with HOCM, 244 fulfilled inclusion criteria of severe resting/provoked outflow gradients of 50 mm Hg or higher, and symptoms of New York Heart Association functional class of II or higher refractory to maximum tolerated medications. After discussion among the heart team, 40 patients underwent surgical or alcohol septal reduction therapy and 4 required treatment of significant coronary artery disease. INTERVENTIONS PIMSRA performed in patients. MAIN OUTCOMES AND MEASURESThe primary outcome was 30-day major adverse clinical events: death, emergency surgery, severe effusion requiring intervention, procedure-related stroke, bleeding, and stroke. Secondary outcomes included 30-day technical success and 90-day improvement in outflow obstruction. RESULTSThe mean (SD) age of 200 patients was 46.9 (14.0) years, and 125 (62.5%) were men. Resting or provoked left ventricular outflow tract gradients were 50 mm Hg or higher. The median (IQR) follow-up for all patients was 19 (6-50) months. Thirty-day major adverse clinical events rate was 10.5% (n = 21): there were 2 in-hospital/30-day deaths (1.0%), 7 patients (3.5%) with pericardial effusion requiring mini-thoracotomy, 12 patients (6%) with pericardial effusion requiring pericardiocentesis, and no bleeding or strokes. Other periprocedural complications included permanent right bundle branch block in 5 patients (2.5%), resuscitated ventricular fibrillation in 2 (1.0%), and septal branch aneurysm in 2 (1.0%). There were no permanent pacemaker implantations. At follow-up, maximum septal thickness was reduced from a mean (SD) of 24.0 (5.1) mm to 17.3 (4.4) mm (P < .001), and left ventricular outflow tract gradient was decreased from a mean (SD) of 79.0 (53.0) mm Hg to 14.0 (24.0) mm Hg (P < .001). Overall, 190 patients (96%) with HOCM were in New York Heart Association functional class I or II at last follow-up.CONCLUSIONS AND RELEVANCE This study found that PIMSRA in patients with drug-refractory HOCM may be an effective procedure for relief of left ventricular outflow tract obstruction and symptoms with acceptable complication rates. These results are encouraging and support the design of a randomized clinical trial against well-established septal reduction therapies.

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Radiofrequency septal reduction in symptomatic hypertrophic obstructive cardiomyopathy

Cited by 35 publications

References 14 publications

Efficacy and safety of radiofrequency ablation for hypertrophic obstructive cardiomyopathy: A systematic review and meta‐analysis

Efficacy and safety of radiofrequency ablation for hypertrophic obstructive cardiomyopathy: A systematic review and meta‐analysis

Hypertrophic cardiomyopathy: the future of treatment

Percutaneous Intramyocardial Septal Radiofrequency Ablation in Patients With Drug-Refractory Hypertrophic Obstructive Cardiomyopathy

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