Endocardial Radiofrequency Ablation vs. Septal Myectomy in Patients With Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-Analysis

Abstract

BackgroundSeptal myectomy (SM) has been the gold standard therapy for most patients with hypertrophic obstructive cardiomyopathy (HOCM). Endocardial radiofrequency ablation of septal hypertrophy (ERASH) is a novel treatment for septal reduction. We aimed to assess the efficacy and safety between two treatment strategies.MethodsWe searched PubMed, Web of Science, Cochrane Library, and Embase databases to identify relevant studies published up to March 2021. Random-effect models were used to calculate standardized mean difference (SMD) and 95% confidence intervals (CIs) for resting left ventricular outflow tract gradient (LVOTG) and septal thickness.ResultsTwenty-five studies are included in this review, eighteen studies for SM and seven studies for ERASH. During follow-up, there were significant reductions of the mean resting LVOTG in adults (SM groups: SMD = −3.03, 95% CI [−3.62 to −2.44]; ERASH groups: SMD = −1.95, 95% CI [−2.45 to −1.45]) and children (SM groups: SMD = −2.67, 95% CI [−3.21 to −2.12]; ERASH groups: SMD= −2.37, 95% CI [−3.02 to −1.73]) after the septal reduction therapies. For adults, SM groups contributed to more obvious reduction than ERASH groups in interventricular septal thickness (SM groups: SMD = −1.82, 95% CI [−2.29 to −1.34]; ERASH groups: SMD = −0.43, 95% CI [−1.00 to 0.13]). The improvement of the New York Heart Association class was similar in the two groups (SM groups: 46.4%; ERASH groups: 46.7%). The periprocedural mortality in SM and ERASH were 1.1 and 1.8%, respectively.ConclusionsThis systematic review suggests that SM is superior to ERASH in the treatment of HOCM. But for the patients who are at risk for open cardiac surgeries or prefer a less invasive approach, ERASH might be an optional approach.

Radiofrequency Catheter Septal Ablation via a Trans-Atrial Septal Approach Guided by Intracardiac Echocardiography in Hypertrophic Obstructive Cardiomyopathy: One-Year Follow-Up

“…However, its success relies on suitable septal arterial anatomy and has the risk of procedure-related atrioventricular conduction complications [ 17 ]. Radiofrequency (RF) ablation is a new method for septal reduction, which is both minimally invasive and independent of coronary anatomy and has been shown to be feasible in HOCM [ 18 , 19 ]. The CARTO sound technology in patients undergoing radiofrequency septal ablation defines the ablation target with previously unparalleled accuracy [ 11 ].…”

Delayed Reduction in Left Ventricular Outflow Tract Gradient After Endocardial Radiofrequency Ablation for Septal Hypertrophy In a Patient with Hypertrophic Obstructive Cardiomyopathy: A Case Report

“…Although septal myectomy provides symptom relief, owing to massive trauma and long convalescence, older patients have a lower expectation of the surgical procedure [8,9]. Therefore, ablation is more suitable for older patients.…”

A Narrative Review of Emerging Therapies for Hypertrophic Obstructive Cardiomyopathy

“…The study found that TSM was associated with similar procedural success rates and long-term outcomes compared to traditional septal myectomy. TSM may be a suitable alternative for patients with MVO who are not candidates for traditional septal myectomy [ 21 ].…”

“…The options for patients with drug-refractory symptoms, who had an obstructive LVOT, included surgical myectomy, ASA, and short atrioventricular delay pacing. The best treatment for LVOT obstruction is still debatable since there are not enough randomized trials that directly examine different medications for the ailment [ 17 - 21 ]. According to recent data, ASA and septal myectomy are not associated with changes in short- and long-term all-cause mortality, cardiovascular mortality, or sudden cardiac death.…”