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Percutaneous Intramyocardial Septal Radiofrequency Ablation For Drug-refractory Hypertrophic Obstructive Cardiomyopathy
Xiang Zhou, Zhengdong Hua, Rong Zhou.
Wuhan Asia Heart Hospital, Wuhan, China.
BACKGROUND: Hypertrophic obstructive cardiomyopathy (HOCM) patients who remain symptomatic despite optimal medical therapy face limited options, with surgical myectomy and alcohol septal ablation carrying specific risks. Percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) has emerged as a novel, minimally invasive therapeutic alternative. This study aims to evaluate the midterm outcomes of PIMSRA for drug-refractory HOCM in a large, single-center cohort.
METHODS: We conducted a retrospective analysis of 210 consecutive patients with drug-refractory HOCM who underwent PIMSRA at our institution between December 2019 and January 2026. The procedure was performed under general anesthesia with guidance by transesophageal echocardiography. Key echocardiographic parameters, including maximal interventricular septal (IVS) thickness and left ventricular outflow tract (LVOT) gradients, were assessed at baseline and during a mean follow-up of 32.9±10.5 months. Procedural details, peri-procedural complications, and follow-up adverse events were systematically recorded.
RESULTS: The procedure was successfully completed in all patients with no in-hospital mortality. At a mean follow-up of over two years, there were no instances of sudden cardiac death. We observed a highly significant reduction in maximal IVS thickness from 27.5 ± 5.7 mm to 18.3 ± 3.8 mm (p<0.001). The resting LVOT peak gradient decreased dramatically from 66.1 ± 40.8 mmHg to 16.2 ± 11.7 mmHg (p<0.001). Significant reverse remodeling was evidenced by marked reductions in left atrial volume index and left ventricular mass index. Notably, no procedure-related high-grade atrioventricular block, new bundle branch block, ventricular septal perforation, or need for permanent pacemaker implantation occurred. Pericardial effusion occurred in 9 (4.2%) patients, of whom 1 patient (0.5%) required left thoracotomy after pericardiocentesis, while the remaining 8 (3.8%) resolved with pericardiocentesis alone.
CONCLUSIONS: PIMSRA demonstrates excellent midterm efficacy in achieving sustained relief of LVOT obstruction and significant septal thickness reduction in patients with drug-refractory HOCM. Its safety profile appears favorable, particularly with a negligible risk of inducing complete heart block requiring permanent pacing. These results position PIMSRA as a promising and safe minimally invasive treatment option. Further prospective, multicenter studies with extended follow-up are warranted to confirm its long-term durability and role in the therapeutic algorithm for HOCM.
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