The Canadian journal of cardiology · 2025
Percutaneous Intramyocardial Septal Radiofrequency Ablation for Hypertrophic Cardiomyopathy With Residual Obstruction After Alcohol Septal Ablation.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Zhang Juan, Hsi David H, Ta Shengjun, Wang Jing, Wang Bo, Ma Hui, Shan Bo, Hu Rui, Li Jing, Liu Liwen
Аннотация
BACKGROUND: Alcohol septal ablation (ASA) is a well established septal reduction therapy for patients with obstructive hypertrophic cardiomyopathy (oHCM). However, research has shown that some patients exhibit persistent severe symptoms and residual left ventricular outflow tract (LVOT) obstruction after ASA, thereby necessitating repeated septal reduction therapy. The feasibility of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) in oHCM patients with residual LVOT obstruction after ASA remains unknown.
METHODS: We analyzed 12 oHCM patients who underwent PIMSRA after ASA had failed at Xijing Hospital between January 2017 and August 2023, and evaluated their clinical characteristics, imaging parameters, and follow-up outcomes.
RESULTS: All 12 patients successfully underwent the PIMSRA procedure. Within the 30-day postprocedure period, no mortality or permanent pacemaker implantation was observed. The median follow-up duration was 12 (4.5-16.5) months. The New York Heart Association classification significantly improved from a median of class 3.0 (interquartile range [IQR], 1) to 2 (IQR, 1). Additionally, the 6-minute walking distance increased from 420 (IQR, 60.9) m to 503 (IQR, 83) m (P < 0.05). Post-PIMSRA, 11 patients (92%) had a resting LVOT residual gradient < 50 mm Hg, including 7 patients (58%) with a resting LVOT residual gradient < 30 mm Hg. One patient (8%) showed a provocable LVOT residual gradient > 50 mm Hg (170 mm Hg at baseline to 51 mm Hg at 6 months) but with significant symptomatic improvement. During the follow-up period, all patients survived, and no permanent pacemaker or implantable cardioverter defibrillator implantation occurred. Moreover, there were no incidences of aborted sudden cardiac death, sustained ventricular tachycardia, or acute systolic heart failure during the follow-up period.
CONCLUSIONS: PIMSRA is a feasible therapeutic option for treating oHCM patients with residual LVOT obstruction after ASA has failed. However, further studies are required to validate the efficacy and safety of its application in a large study cohort.
CLINICAL TRIAL REGISTRATION: NCT06496633.
METHODS: We analyzed 12 oHCM patients who underwent PIMSRA after ASA had failed at Xijing Hospital between January 2017 and August 2023, and evaluated their clinical characteristics, imaging parameters, and follow-up outcomes.
RESULTS: All 12 patients successfully underwent the PIMSRA procedure. Within the 30-day postprocedure period, no mortality or permanent pacemaker implantation was observed. The median follow-up duration was 12 (4.5-16.5) months. The New York Heart Association classification significantly improved from a median of class 3.0 (interquartile range [IQR], 1) to 2 (IQR, 1). Additionally, the 6-minute walking distance increased from 420 (IQR, 60.9) m to 503 (IQR, 83) m (P < 0.05). Post-PIMSRA, 11 patients (92%) had a resting LVOT residual gradient < 50 mm Hg, including 7 patients (58%) with a resting LVOT residual gradient < 30 mm Hg. One patient (8%) showed a provocable LVOT residual gradient > 50 mm Hg (170 mm Hg at baseline to 51 mm Hg at 6 months) but with significant symptomatic improvement. During the follow-up period, all patients survived, and no permanent pacemaker or implantable cardioverter defibrillator implantation occurred. Moreover, there were no incidences of aborted sudden cardiac death, sustained ventricular tachycardia, or acute systolic heart failure during the follow-up period.
CONCLUSIONS: PIMSRA is a feasible therapeutic option for treating oHCM patients with residual LVOT obstruction after ASA has failed. However, further studies are required to validate the efficacy and safety of its application in a large study cohort.
CLINICAL TRIAL REGISTRATION: NCT06496633.