Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey

The mean age was 60.7 ± 12 years.In 8 patients previous transcoronary ablation of septal hypertrophy (TASH) had been ineffective.The RF energy was delivered to the most proximal parts of the septum in the immediate vicinity of LVOT.A region of 2 cm was ablated with a therapeutic end point of achieving a gradient of <50 mmHg.In 9 patients, the left ventricular septum was ablated, and in 10 patients, the right ventricular septum was ablated.Follow-up examinations (echocardiography, 6-minute walk test, bicycle ergometry) were performed 3 days and 6 months after ERASH.The procedure resulted in reduction of 62% in resting gradients and 60% in provoked gradients.It was associated with improvement in New York Heart Association (NYHA) class (from 3.0 ± 0.0 to 1.6 ± 0.7) and 6-minute walk test (from 412.9 ± 129 m to 471.2 ± 139 m) all of which were sustained at 6 months.In this series 21% had atrioventricular (AV) block requiring permanent pacemaker implantation and 1 patient had cardiac tamponade.It is possible that conduction system damage could have resulted from deep lesions caused by high RF energy (40-70 W), delivered by irrigated tip ablation catheter particularly when right ventricular side of the septum was ablated.The ERASH is a promising therapy for obstructive HOCM; however, further refinements in procedure are necessary before this procedure can be offered on a larger scale.