Key result
Percutaneous septal radiofrequency ablation achieves target LVOT gradients in ~92% of oHCM patients failing alcohol ablation.
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Why the study?
Some patients with oHCM have persistent severe symptoms and residual LVOT obstruction after ASA, but the feasibility of PIMSRA in this population remains unknown.
Does percutaneous intramyocardial septal radiofrequency ablation improve symptoms and reduce LVOT gradient in oHCM patients with residual obstruction after failed alcohol septal ablation?
Observational (n=12)
No
Does percutaneous intramyocardial septal radiofrequency ablation improve symptoms and reduce LVOT gradient in oHCM patients with residual obstruction after failed alcohol septal ablation?
PIMSRA appears to be a feasible and safe therapeutic option that improves symptoms and reduces LVOT gradients in oHCM patients with residual obstruction after failed alcohol septal ablation.
BACKGROUND Alcohol septal ablation (ASA) is a well-established septal reduction therapy (SRT) for patients with obstructive hypertrophic cardiomyopathy (oHCM). However, research has shown that some patients exhibit persistent severe symptoms and residual left ventricular outflow tract (LVOT) obstruction following ASA, thereby necessitating repeated SRT. The feasibility of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) in oHCM patients with residual LVOT obstruction after ASA remains unknown. METHOD We analyzed 12 oHCM patients who underwent PIMSRA after failed ASA at Xijing Hospital between January 2017 and August 2023, evaluating their clinical characteristics, imaging parameters, and follow-up outcomes. RESULTS All 12 patients successfully underwent the PIMSRA procedure. Within the 30-day post-procedure period, no mortality or permanent pacemaker (PPM) implantation was observed. The median follow-up duration was 12 (4.5-16.5) months. The New York Heart Association (NYHA) classification significantly improved from a median of class 3.0 (IQR:1) to 2 (IQR:1). Additionally, the 6-minute walking distance increased from 420 (IQR:60.9) meters to 503 (IQR:83) meters (p <0.05). Post-PIMSRA, 11 patients (92%) had a resting LVOT residual gradient <50 mm Hg, including 7 patients (58%) with a resting LVOT residual gradient <30 mm Hg. One patient (8%) showed a provocable LVOT residual gradient >50 mm Hg (170 mmHg at baseline to 51 mmHg at 6 months) but with significant symptomatic improvement. During the follow-up period, all patients survived, and no PPM or implantable cardioverter defibrillator (ICD) implantation occurred. Moreover, there were no incidences of aborted sudden cardiac death (SCD), sustained ventricular tachycardia, or acute systolic heart failure during the follow-up period. CONCLUSION PIMSRA is a feasible therapeutic option for treating oHCM patients with residual LVOT obstruction following failed ASA. However, further studies are required to validate the efficacy and safety of its application in a large study cohort.
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Zhang et al. (2025) conducted an observational in Obstructive hypertrophic cardiomyopathy (oHCM) with residual LVOT obstruction after alcohol septal ablation (n=12). Percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) was evaluated on Resting LVOT residual gradient <50 mm Hg. Percutaneous intramyocardial septal radiofrequency ablation in 12 oHCM patients with failed prior alcohol septal ablation resulted in 92% achieving a resting LVOT residual gradient <50 mm Hg.
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