A novel approach in the use of radiofrequency catheter ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy

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• 作者：Abhijeet B. Shelke^a ; Rajeev Menon^b ; Anuj Kapadiya^b ; Sachin Yalagudri^a ; Daljeet Saggu^a ; Sandeep Nair^a ; C. Narasimhan^a ; ^{calambur1@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; ^{calambur@hotmail.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：LVOT ; left ventricular outflow tract obstruction ; ASA ; alcohol septal ablation ; RFCA ; radio frequency catheter ablation ; HOCM ; hypertrophic obstructive cardiomyopathy ; LAD ; left anterior descending artery ; ICE ; intra cardiac echocardiography ; LBB ; left bundle branch ; CHB ; complete heart block
• 刊名：Indian Heart Journal
• 出版年：2016
• 出版时间：September-October 2016
• 年：2016
• 卷：68
• 期：5
• 页码：618-623
• 全文大小：839 K

文摘

Alcohol septal ablation (ASA) is a therapeutic alternative to surgical myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM). However, the anatomical variability of the septal branch, risk of complete heart block, and late onset ventricular arrhythmias are limitations to its therapeutic usage. There is recent interest in the use of radiofrequency catheter ablation (RFCA) as a therapeutic option in HOCM. We aimed to assess the safety and efficacy of RFCA in the treatment of symptomatic HOCM.

Methods

Seven patients with symptomatic HOCM (mean age 43.7 ± 15.6 years, five males), and significant left ventricular outflow tract (LVOT) gradient despite optimal drug therapy, underwent ablation of the hypertrophied interventricular septum. These patients had unfavorable anatomy for ASA. Ablation was performed under 3D electro-anatomical system guidance using an open irrigated tip catheter. The region of maximal LV septal bulge as seen on intracardiac echocardiography was targeted. Patients were followed up at 1, 6, and 12 months post-procedure.

Results

The mean baseline LVOT gradient by Doppler echocardiography was 81 ± 14.8 mm of Hg which reduced to 48.5 ± 22.6 (p = 0.0004), 49.8 ± 19.3 (p = 0.0004), and 42.8 ± 26.1 mm of Hg (p = 0.05) at 1, 6, and 12 months respectively. Symptoms improved at least by one NYHA class in all but one patient. One patient developed transient pulmonary edema post-RFA. There were no other complications.

Conclusion

RFCA of the hypertrophied septum causes sustained reduction in the LVOT gradient and symptomatic improvement among patients with HOCM. Electroanatomical mapping helps to perform the procedure safely.