Radiofrequency ablation of the interventricular septum to treat outflow tract gradients in hypertrophic obstructive cardiomyopathy: a novel use of CARTOSound<sup>®</sup>technology to guide ablation

Cooper, Robert; Shahzad, Adeel; Hasleton, Jonathan; DiGiovanni, Joseph; Hall, Mark; Todd, Derick; Modi, Simon; Stables, Rodney H

doi:10.1093/europace/euv302

Cited by 50 publications

(76 citation statements)

References 18 publications

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“…Cooper и соавт. описали 5 пациентов, перенесших ЭРЧА ГП, у которых регистрировали уменьшение градиентов давления в ВТ ЛЖ в покое и в пробе Вальсальвы, а также улучшение функционального класса по NYHA [16].…”

Section: Discussionunclassified

Anesthetic management during endocardial radiofrequency ablation of septal hypertrophy – a case report

et al. 2019

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Background: Hypertrophic cardiomyopathy (HCM) is a genetic disorder present in up to 1/500 individuals, about 20–30% of them presenting with hypertrophic obstructive cardiomyopathy (HOCM) due to left ventricle outflow tract obstruction. This is an important cause of sudden cardiac death. Endocardial radiofrequency ablation of septal hypertrophy (ERASH) might be an attractive treatment for HOCM, particularly in patients who do not respond to transcoronary alcohol septal ablation (TASA).Aim: To describe technical aspects related to the procedure and anesthetic management of an ERASH case.Case report: A 64-year-old woman with HOCM was scheduled for ERASH. She had worsening of dyspnea on exertion and generalized fatigue for the previous weeks after previous surgical myomectomy about 6 months ago. The anatomy was unfavorable for TASA and the patient was not willing to undergo another surgery. Preoperative transthoracic echocardiography (TTE) showed asymmetric mid-septal hypertrophy, systolic anterior motion with septal contact and left ventricular outflow tract maximum gradient of 68 mmHg at rest and 105 mmHg after the Valsalva maneuver. General anesthesia was performed. Pulse pressure variation, echocardiography parameters and passive leg raising test where used to guide fluid therapy. At the end of the procedure, analgesia was provided together with prophylaxis of nausea and vomiting. Extubation was uneventful and the patient was transported to the intensive care unit eupneic and hemodynamically stable. On the fourth postoperative day, TTE showed septal hypocontractility and maximum gradient reduction of 33% at rest (68 mmHg to 45 mmHg) and 31% after the Valsalva maneuver (105 mmHg to 73 mmHg). The patient was discharged from hospital at the sixth postoperative day. One month later, she reported progressive improvement of symptoms and expressed satisfaction with the results.Conclusion: Better understanding of the pathophysiology and natural history of HCM has enabled earlier diagnosis, as well as a more adequate therapeutic approach. Anesthesiologists should be aware of the pathophysiology of HOCM and must be prepared to anticipate the hemodynamic changes and cardiovascular instability that such patients may show perioperatively. ERASH is a promising therapeutic modality increasingly used for HOCM and anesthesiologists should become more familiar with it.

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Section: Discussionunclassified

Anesthetic management during endocardial radiofrequency ablation of septal hypertrophy – a case report

et al. 2019

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“…But the procedure did not result in a significant, sustained reduction in LVOT gradient in 2 of the 3 patients. Cooper et al used radiofrequency (RF) energy guided by CARTOSound and intra‐cardiac echocardiography to directly ablate the interventricular septum at the mitral valve (MV) systolic anterior motion (SAM)‐septal contact point in 5 patients, which resulted in the resting LVOT gradient improved from 64.2 (±50.6) to 12.3 (±2.5) mm Hg. Lawrenz's team studied the efficacy and safety of endocardial radiofrequency ablation of septal hypertrophy (ERASH) with ablation of the right or left ventricular septum with similar results of 62% reduction in resting gradients.…”

Section: Discussionmentioning

confidence: 99%

Echocardiography Guided Liwen Procedure^™ for the treatment of obstructive hypertrophic cardiomyopathy in a patient with prior aortic valve replacement surgery

et al. 2018

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We successfully treated a patient who was diagnosed of having hypertrophic obstructive cardiomyopathy after the aortic valve replacement surgery for the concomitant aortic stenosis. We report this first in kind new procedure exclusively developed in our center, Liwen procedure (percutaneous intramyocardial septal radiofrequency ablation), for patients with left ventricular outflow tract obstruction in spite of maximal medical therapy. The procedure was performed under transthoracic echo guidance. We discussed the technical details, safety, and effectiveness with corresponding images. The patient did well one year after the procedure without LVOT obstruction or arrhythmia.

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“…Several small series have since been published ( n = 74) . Septal reduction remains modest (1–2 mm compared to ∼5–6 mm with ASA), likely due to the limited subendocardial delivery of energy and lesion formation.…”

Section: Novel Procedural Techniques For Hypertrophic Cardiomyopathymentioning

confidence: 99%

“…Several small series have since been published (n = 74). [90][91][92][93] Septal reduction remains modest (1-2 mm compared to ∼5-6 mm with ASA), likely due to the limited subendocardial delivery of energy and lesion formation. Two procedure-related deaths were reported due to retroperitoneal bleed and paradoxical increase in LVOT gradient (due to tissue oedema), as well as an 11% rate of CHB.…”

Section: Radiofrequency Ablationmentioning

confidence: 99%

Hypertrophic cardiomyopathy: the future of treatment

Tuohy

Kaul

Song

et al. 2020

European J of Heart Fail

131

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Hypertrophic cardiomyopathy (HCM) is a heterogeneous genetic disorder most often caused by sarcomeric mutations resulting in left ventricular hypertrophy, fibrosis, hypercontractility, and reduced compliance. It is the most common inherited monogenic cardiac condition, affecting 0.2% of the population. Whereas currently available therapies for HCM have been effective in reducing morbidity, there remain important unmet needs in the treatment of both the obstructive and non‐obstructive phenotypes. Novel pharmacotherapies directly target the molecular underpinnings of HCM, while innovative procedural techniques may soon offer minimally‐invasive alternatives to current septal reduction therapy. With the advent of embryonic gene editing, there now exists the potential to correct underlying genetic mutations that may result in disease. This article details the recent developments in the treatment of HCM including pharmacotherapy, septal reduction procedures, mitral valve manipulation, and gene‐based therapies.

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Radiofrequency ablation of the interventricular septum to treat outflow tract gradients in hypertrophic obstructive cardiomyopathy: a novel use of CARTOSound^®technology to guide ablation

Abstract: Radiofrequency ablation using CARTOSound(®) guidance is accurate and effective in treating LVOT gradients in HOCM in this preliminary group of patients.

Cited by 50 publications

References 18 publications

Anesthetic management during endocardial radiofrequency ablation of septal hypertrophy – a case report

Anesthetic management during endocardial radiofrequency ablation of septal hypertrophy – a case report

Echocardiography Guided Liwen Procedure^™ for the treatment of obstructive hypertrophic cardiomyopathy in a patient with prior aortic valve replacement surgery

Hypertrophic cardiomyopathy: the future of treatment

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Radiofrequency ablation of the interventricular septum to treat outflow tract gradients in hypertrophic obstructive cardiomyopathy: a novel use of CARTOSound®technology to guide ablation

Abstract: Radiofrequency ablation using CARTOSound(®) guidance is accurate and effective in treating LVOT gradients in HOCM in this preliminary group of patients.

Cited by 50 publications

References 18 publications

Anesthetic management during endocardial radiofrequency ablation of septal hypertrophy – a case report

Anesthetic management during endocardial radiofrequency ablation of septal hypertrophy – a case report

Echocardiography Guided Liwen Procedure™ for the treatment of obstructive hypertrophic cardiomyopathy in a patient with prior aortic valve replacement surgery

Hypertrophic cardiomyopathy: the future of treatment

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Product

Resources

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Radiofrequency ablation of the interventricular septum to treat outflow tract gradients in hypertrophic obstructive cardiomyopathy: a novel use of CARTOSound^®technology to guide ablation

Echocardiography Guided Liwen Procedure^™ for the treatment of obstructive hypertrophic cardiomyopathy in a patient with prior aortic valve replacement surgery