Key result
Radiofrequency septal ablation lowers peak LVOT gradient ~74% as post-TMVR bailout therapy.
Why the study?
Left ventricular outflow tract obstruction is an important complication of TMVR, but radiofrequency ablation for septal reduction had not been reported in the postoperative setting.
Does radiofrequency catheter ablation reduce LVOT obstruction in patients who develop it after transcatheter mitral valve replacement?
Case Report (n=1)
No
Does radiofrequency catheter ablation reduce LVOT obstruction in patients who develop it after transcatheter mitral valve replacement?
Radiofrequency catheter ablation is a feasible and novel bailout strategy for septal reduction in patients who develop significant LVOT obstruction after transcatheter mitral valve replacement.
May warrant consideration as bailout for refractory post-TMVR LVOT obstruction; leaves open need for prospective safety and efficacy data.
BACKGROUND: Transcatheter mitral valve replacement (TMVR) has emerged as an important treatment for mitral stenosis. Radiofrequency catheter ablation has been shown to be effective as a pre-emptive strategy to mitigate left ventricular outflow tract (LVOT) obstruction. CASE SUMMARY: A 78-year-old man undergoes a TMVR. He develops significant LVOT obstruction. Radiofrequency ablation is used as a therapeutic procedure. DISCUSSION: LVOT obstruction is an important complication of TMVR. Various strategies have been used preoperatively to prevent the development of LVOT obstruction. Although radiofrequency ablation has been used as a means of septal reduction, there has been no prior reported case of this strategy in the postoperative setting. TAKE-HOME MESSAGES: LVOT obstruction remains a significant anatomic limitation in patients undergoing TMVR. This case illustrates the feasibility and novelty of septal reduction therapy with conventional radiofrequency ablation catheters in patients who develop significant LVOT obstruction after TMVR intervention as a bailout therapy.
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Katrapati et al. (2026) conducted a case report in Left ventricular outflow tract obstruction after transcatheter mitral valve replacement (n=1). Radiofrequency catheter ablation was evaluated on Peak LVOT gradient. Radiofrequency catheter ablation successfully reduced the peak left ventricular outflow tract gradient from 65 mm Hg to 17 mm Hg at 45 days post-procedure as a bailout therapy after TMVR.
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