Key result
Endocardial radiofrequency ablation of septal hypertrophy reduced the resting gradient by 67% (p=0.0002), but was associated with a 9% rate of life-threatening paradoxical increase in obstruction.
Why the study?
Endocardial radiofrequency ablation of septal hypertrophy (ERASH) is an alternative to alcohol septal ablation or surgical myectomy in HOCM, but data focused on severe complications were needed.
Does endocardial radiofrequency ablation of septal hypertrophy (ERASH) reduce outflow tract gradient and what is its safety profile in patients with HOCM?
Observational (n=41)
No
Does endocardial radiofrequency ablation of septal hypertrophy (ERASH) reduce outflow tract gradient and what is its safety profile in patients with HOCM?
p-value: p=0.0002
ERASH effectively reduces outflow tract gradients in HOCM but carries a high risk of severe complications, including pacemaker dependency and paradoxical increase in obstruction, suggesting it should be reserved for patients ineligible for surgical myectomy or alcohol septal ablation.
INTRODUCTION: Endocardial radiofrequency ablation of septal hypertrophy (ERASH) is an alternative to alcohol septal ablation (ASA) or surgical myectomy for hypertrophic obstructive cardiomyopathy (HOCM). Several studies have confirmed that septal radiofrequency ablation leads to a significant reduction in the left ventricular outflow tract gradient. OBJECTIVES: We aimed to report the outcomes of 41 patients who underwent ERASH with a focus on severe complications. METHODS: Since 2004, 41 patients with HOCM (age: 58.2 ± 13 years) underwent ERASH at our institution. ERASH was performed, since ASA was ineffective (26 patients) or not possible (15 patients). RESULTS: The left ventricular outflow tract and the right ventricular septum were ablated in 26 and 15 patients, respectively. ERASH resulted in a significant reduction in acute gradient during the session and the results persisted during the 6-month follow-up (67% gradient reduction at rest and 73% after provocation, p = .0002). Pacemaker dependency after ERASH was 29% and pericardial tamponade occurred in two patients. In four patients, ERASH induced a paradoxical increase in obstruction (PIO), beginning suddenly at 30 min after the procedure and leading to lethal shock in one patient. PIO was not observed after ERASH from the right ventricular aspect. CONCLUSION: Morbidity and mortality after ERASH were higher than those after ASA. PIO, a life-threatening complication, was observed in 9% of the patients. Our data indicate that ERASH might be considered in patients who are not candidates for surgical myectomy or ASA.
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Lawrenz et al. (2021) conducted an observational in Hypertrophic obstructive cardiomyopathy (HOCM) (n=41). Endocardial radiofrequency ablation of septal hypertrophy (ERASH) was evaluated on Gradient reduction at rest (p=0.0002). Endocardial radiofrequency ablation of septal hypertrophy reduced the resting gradient by 67% (p=0.0002), but was associated with a 9% rate of life-threatening paradoxical increase in obstruction.
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