Percutaneous Intramyocardial Septal Radiofrequency Ablation (Liwen Procedure) for Hypertrophic Cardiomyopathy: A Decade of Evolution, Clinical Experience and Future Perspectives

Q: What is the clinical evidence from this study?

Study design: Review. Population: Obstructive Hypertrophic Cardiomyopathy (oHCM). Intervention: Percutaneous intramyocardial septal radiofrequency ablation (PIMSRA/Liwen procedure).

Liwen Liu; Jing Li; Shaonan Dang; David H. Hsi; Shengjun Ta

doi:10.26599/audt.2026.260038

October 29, 2026Advanced ultrasound in diagnosis and therapyOpen Access

Percutaneous Intramyocardial Septal Radiofrequency Ablation (Liwen Procedure) for Hypertrophic Cardiomyopathy: A Decade of Evolution, Clinical Experience and Future Perspectives

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Key result

Percutaneous intramyocardial septal radiofrequency ablation achieves ~1% 30-day mortality with durable 5-year gradient reduction in oHCM.

Why the study?

Percutaneous intramyocardial septal radiofrequency ablation (PIMSRA/Liwen procedure) has recently emerged as a novel septal reduction therapy for patients with obstructive HCM, warranting a summary of its ten-year development, current knowledge, and issues requiring further investigation.

Does percutaneous intramyocardial septal radiofrequency ablation (PIMSRA/Liwen procedure) safely and effectively reduce septal thickness and left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy?

Key Points

To review the ten-year evolution, technical principles, clinical safety, efficacy, and future directions of percutaneous intramyocardial septal radiofrequency ablation for hypertrophic cardiomyopathy.
Narrative review synthesizing evidence from preclinical sheep and canine models to clinical studies evaluating the Liwen procedure.
Summarized echocardiography-guided trans-apical needle radiofrequency ablation delivering localized thermal injury (>80°C) to induce coagulative necrosis in the interventricular septum.
Clinical evaluations demonstrate that targeted thermal injury successfully thins the interventricular septum and relieves left ventricular outflow tract obstruction.
In patients undergoing concomitant ablation with off-pump minimally invasive direct coronary artery bypass, left ventricular outflow tract gradient decreased from 66 to 9 mmHg at 1-month follow-up.
Emerging applications currently explored in small case series include failed alcohol septal ablation, apical aneurysm, Fabry disease with obstruction, and cardiac tumors.

Structured PICO

Does percutaneous intramyocardial septal radiofrequency ablation (PIMSRA/Liwen procedure) safely and effectively reduce septal thickness and left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy?

P

Population

Adult patients with drug-refractory obstructive hypertrophic cardiomyopathy undergoing percutaneous intramyocardial septal radiofrequency ablation across clinical studies with up to 5 years of follow-up.

I

Intervention

Percutaneous intramyocardial septal radiofrequency ablation (PIMSRA/Liwen procedure), delivering targeted radiofrequency energy via a percutaneous trans-apical approach to the hypertrophied interventricular septum under continuous real-time transthoracic echocardiographic guidance.

C

Comparator

Surgical septal myectomy (SM) and alcohol septal ablation (ASA) discussed as established septal reduction therapy modalities in the narrative review (no direct randomized or propensity score-matched comparator in the primary PIMSRA studies).

This review summarizes ten years of clinical experience showing that echocardiographically guided percutaneous intramyocardial septal radiofrequency ablation (PIMSRA/Liwen procedure) provides durable relief of left ventricular outflow tract obstruction in obstructive hypertrophic cardiomyopathy with low periprocedural mortality and zero permanent pacemaker implantation.

Limitations

No rigorous propensity score-matched or randomized studies have directly compared the PIMSRA/Liwen procedure with surgical myectomy or alcohol septal ablation.
A substantial proportion of available clinical evidence originates from a single center (Xijing Hospital), and independent multicenter validation remains relatively limited.
Evidence for extended applications beyond obstructive HCM (such as non-obstructive HCM, failed alcohol septal ablation, Fabry disease, and cardiac tumors) is limited to small case series or case reports.
No rigorous propensity score-matched study has yet directly compared PIMSRA/Liwen with surgical myectomy or alcohol septal ablation
A substantial proportion of the available evidence originates from a single center (Xijing Hospital), and independent multicenter validation remains relatively limited
Current evidence for potentially extended applications beyond oHCM remains exploratory and limited to small case series or case reports

Implication

Low procedural risks with durable gradient reduction in oHCM may inform options; leaves open randomized comparisons to myectomy or alcohol ablation.

Abstract

Hypertrophic cardiomyopathy (HCM) is an inherited cardiomyopathy. For patients with obstructive hypertrophic cardiomyopathy (oHCM) who remain symptomatic despite medical therapy, septal reduction therapy can be performed. Surgical septal myectomy and alcohol septal ablation are the treatments for relieving left ventricular outflow tract obstruction and can effectively improve patients’ quality of life. In recent years, percutaneous intramyocardial septal radiofrequency ablation (PIMSRA/Liwen procedure) has emerged as a novel treatment for oHCM. This review traces its ten-year development from animal experiments to clinical application, covering technical principles, safety, and efficacy. Additional potentially extended applications are being explored, including non-obstructive HCM and other coexisting cardiac conditions. Future directions include longer-term follow-up, and multicenter collaboration to validate efficacy and safety in HCM patients. This review summarizes the current knowledge on PIMSRA/Liwen procedure and raises several issues that deserve further investigation.

Discussion

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Cite This Study

Liu et al. (2026) conducted a review in Obstructive Hypertrophic Cardiomyopathy (oHCM). Percutaneous intramyocardial septal radiofrequency ablation (PIMSRA/Liwen procedure) was evaluated.

synapsesocial.com/papers/6ae5854b4c46c197bbab3cbe https://doi.org/10.26599/audt.2026.260038

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Percutaneous Intramyocardial Septal Radiofrequency Ablation (Liwen Procedure) for Hypertrophic Cardiomyopathy: A Decade of Evolution, Clinical Experience and Future Perspectives

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Percutaneous Intramyocardial Septal Radiofrequency Ablation (Liwen Procedure) for Hypertrophic Cardiomyopathy: A Decade of Evolution, Clinical Experience and Future Perspectives

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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