Radiofrequency Catheter Septal Ablation via a Trans-Atrial Septal Approach Guided by Intracardiac Echocardiography in Hypertrophic Obstructive Cardiomyopathy: One-Year Follow-Up

Xi Li^1,2,†, Tao Liu^1,†, Bo Cui¹, Yanhong Chen³, Cheng Tang^2,*, Gang Wu^1,*

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¹ Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, 430060 Wuhan, Hubei, China

² Department of Cardiology, Wuhan Asia General Hospital, 430060 Wuhan, Hubei, China

³ Department of Cardiology, Wuhan Asian Heart Hospital, 430060 Wuhan, Hubei, China

^*Correspondence: 15927210929@163.com (Cheng Tang); wugangmd@163.com (Gang Wu)
^†These authors contributed equally.

Rev. Cardiovasc. Med. 2024, 25(2), 38; https://doi.org/10.31083/j.rcm2502038

Submitted: 27 July 2023 | Revised: 30 August 2023 | Accepted: 14 September 2023 | Published: 29 January 2024

(This article belongs to the Section Heart Diseases)

This is an open access article under the CC BY 4.0 license.

Abstract

Background: Percutaneous radiofrequency catheter ablation (RFA) in hypertrophic obstructive cardiomyopathy (HOCM) with intracardiac echocardiography (ICE) guidance is a novel method that has been proven to be safe and effective in a small sample size study. RFA of the interventricular septum through a trans-atrial septal approach in HOCM patients with a longer follow-up has not been reported. Methods: 62 consecutive patients from March 2019 to February 2022 were included in this study. The area between the hypertrophied septum and anterior mitral valve (MV) leaflet was established using the three-dimensional system (CARTO 3 system), and all patients received atrial septal puncture under the guidance of intracardiac echocardiography (ICE). Point-by-point ablation was performed to cover the contact area. After ablation, the patients were followed up for 1, 3, 6, and 12 months. Transthoracic echocardiography was performed at 1, 3, 6, and 12 months, and resting and exercise-provoked left ventricular outflow tract (LVOT) gradients were obtained. Results: During the 1-year follow-up, most patients’ symptoms improved. The NYHA grading of the patient decreased from 2 (2, 3) at baseline to 2 (1, 2) (p $<$ 0.001). LVOT peak gradient at rest was decreased from 59 ( $\pm{}$ 27) mmHg to 30 ( $\pm{}$ 24) mmHg (p $<$ 0.001), and the provoked peak gradient was decreased from 99 ( $\pm{}$ 33) mmHg to 59 ( $\pm{}$ 34) mmHg (p $<$ 0.001). The average maximum septal thickness was reduced from 21 ( $\pm{}$ 4) mm to 19 ( $\pm{}$ 4) mm (p $<$ 0.001). Conclusions: After a 1-year follow-up, ice-guided radiofrequency ablation for HOCM might be a safe, accurate, and effective method. The catheter might be reliably attached to the ablation target area via trans-atrial septal access.

Keywords

percutaneous radiofrequency ablation

hypertrophic obstructive cardiomyopathy

transseptal puncture

intracardiac echocardiography

Funding

82270365/National Natural Science Foundation of China

82270243/National Natural Science Foundation of China

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Rev. Cardiovasc. Med. Print ISSN 1530-6550 Electronic ISSN 2153-8174