American heart journal plus : cardiology research and practice · 2022
Radiofrequency ablation in patients with obstructive hypertrophic cardiomyopathy: A systematic review and meta-analysis.
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Canzi Camila Cássia, do Prado Júnior Edivalde Ribeiro, da Silva Menezes Júnior Antônio, Rezende Aline Lazara, Botelho Silvia Marçal, Santos Luciana da Ressurreição
Аннотация
STUDY OBJECTIVE: Hypertrophic cardiomyopathy (HCM) is a genetic disease that can cause left ventricular outflow tract (LVOT) obstruction. This study analyzed the efficacy of radiofrequency ablation (RA) in improving clinical and hemodynamic factors in patients receiving obstructive HCM refractory treatment. This evaluation was necessary because of the small number of studies on the effectiveness of this technique for obstructive HCM in the existing literature.
DESIGN: We used the PubMed, Embase, and Science Direct databases to identify randomized clinical trials and observational studies addressing the clinical and hemodynamic outcomes before and after RA in patients with HCM.
PARTICIPANTS: We selected six articles published between 2011 and 2022, comprising 304 patients (mean age: 45 years).
INTERVENTIONS: We performed a bias assessment using the ROBINS I tool, and meta-analysis processing was performed using the STATA program (v.16.0).
RESULTS: The left ventricular outflow tract (LVOT) gradient at rest and with stimulation decreased by 58.78 mmHg (p = 0.001) and 70.38 mmHg (total effect Z = 21.62; p < 0.0001), respectively. Additionally, the New York Heart Association (NYHA) functional class decreased by 0.43 (p = 0.001), indicating symptomatic and hemodynamic improvements. Furthermore, we observed a significant reduction in septal thickness (by 4 mm; p = 0.001).
CONCLUSIONS: RA improved the NYHA functional class and LVOT gradient at rest and with stimulation and reduced septal thickness. These results suggest that RA is effective in patients refractory to pharmacological therapy and unsuitable for alcohol septal ablation or myectomy. However, more studies, including randomized clinical trials, should be conducted to define the role of RA in interventional therapies.
DESIGN: We used the PubMed, Embase, and Science Direct databases to identify randomized clinical trials and observational studies addressing the clinical and hemodynamic outcomes before and after RA in patients with HCM.
PARTICIPANTS: We selected six articles published between 2011 and 2022, comprising 304 patients (mean age: 45 years).
INTERVENTIONS: We performed a bias assessment using the ROBINS I tool, and meta-analysis processing was performed using the STATA program (v.16.0).
RESULTS: The left ventricular outflow tract (LVOT) gradient at rest and with stimulation decreased by 58.78 mmHg (p = 0.001) and 70.38 mmHg (total effect Z = 21.62; p < 0.0001), respectively. Additionally, the New York Heart Association (NYHA) functional class decreased by 0.43 (p = 0.001), indicating symptomatic and hemodynamic improvements. Furthermore, we observed a significant reduction in septal thickness (by 4 mm; p = 0.001).
CONCLUSIONS: RA improved the NYHA functional class and LVOT gradient at rest and with stimulation and reduced septal thickness. These results suggest that RA is effective in patients refractory to pharmacological therapy and unsuitable for alcohol septal ablation or myectomy. However, more studies, including randomized clinical trials, should be conducted to define the role of RA in interventional therapies.