Endocardial radiofrequency ablation for the treatment of pediatric hypertrophic cardiomyopathy: A report of two cases and a brief review of the literature.

The present case report evaluated the application and outcomes of endocardial radiofrequency ablation (ERFA) in children with hypertrophic cardiomyopathy (HCM). The clinical data, procedural details and short-term follow-up of two pediatric patients with HCM admitted to the department of cardiology from 2023 to 2024. In addition, literature published between 2012 and 2025 was reviewed using the key words 'endocardial radiofrequency ablation', 'children' and 'hypertrophic cardiomyopathy' to summarize the current status and efficacy of ERFA in pediatric HCM. The first reported case was that of a 9-year-old boy who presented with reduced exercise tolerance for 6 months. An echocardiography revealed asymmetric hypertrophy of the interventricular septum and left ventricular wall, positive systolic anterior motion (SAM) sign and left ventricular outflow tract (LVOT) obstruction. Genetic testing indicated variants in LZTR1, suggestive of Noonan syndrome type 10. Despite medication (metoprolol and captopril), LVOT obstruction progressed (gradient >50 mmHg). ERFA was performed, and follow-up at 2 months showed reduced septal thickness and alleviated LVOT obstruction. The second case was that of an 11-year- and -11-month-old girl who presented with 3 years of dizziness and fatigue. An echocardiography confirmed asymmetric left ventricular hypertrophy, LVOT obstruction and SAM sign. Post-ERFA, LVOT obstruction significantly improved. Literature reports on ERFA for pediatric HCM are limited. Combined with adult series, ERFA appears safer than surgical myectomy or alcohol septal ablation, although long-term efficacy requires further validation. On the whole, the present case report demonstrates that ERFA is a safe and effective intervention for pediatric HCM when pharmacological therapy fails, providing a viable minimally alternative.