PMID- 34277806
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220424
IS  - 2305-5839 (Print)
IS  - 2305-5847 (Electronic)
IS  - 2305-5839 (Linking)
VI  - 9
IP  - 12
DP  - 2021 Jun
TI  - A modified endocardial radiofrequency ablation approach for hypertrophic 
      obstructive cardiomyopathy guided by transthoracic echocardiography: a case 
      series.
PG  - 1006
LID - 10.21037/atm-21-2783 [doi]
LID - 1006
AB  - BACKGROUND: A series of studies showed that endocardial radiofrequency ablation 
      (ERFA) could reduce the left ventricular outflow tract (LVOT) gradient in 
      patients with septal hypertrophy. This study aimed to determine the safety and 
      efficacy of a modified ERFA approach guided by transthoracic echocardiography 
      (TTE) as an alternative to ablation performed under a three-dimensional (3D) 
      electroanatomical system or intracardiac echocardiography (ICE). METHODS: 
      Twenty-five patients with hypertrophic obstructive cardiomyopathy (HOCM) 
      underwent ERFA of septal hypertrophy, guided by echocardiography. The LVOT 
      gradient, left ventricular ejection fraction (LVEF), LV thickness, New York Heart 
      Association (NYHA) class, and biochemical laboratory values were recorded before 
      ablation and during follow-up. RESULTS: The patients' peak and stress-induced 
      LVOT gradients were significantly reduced after 12 months of follow-up (resting 
      gradient: from 123.2+/-17.7 to 15.7+/-7.8 mmHg, P<0.05; provocative gradient: from 
      140.2+/-20.8 to 18.4+/-8.0 mmHg, P<0.05). Compared with baseline, the septal diameter 
      was reduced slightly after 12 months, but the difference was not significant 
      (24.8+/-3.5 vs. 24.2+/-3.4 mm, P>0.05). The reduction in LVOT gradient was associated 
      with an improvement in NYHA functional classification (from 3.0+/-0.0 to 1.6+/-0.7, 
      P<0.05), the 6-minute walking distance (413+/-129 m at baseline; 458+/-108 m 
      immediately after ERFA; 471+/-139 m after 12 months, P<0.05), and pro B-type 
      natriuretic peptide levels (from 924.00+/-139 to 137.45 +/-75.73 pg/mL, P<0.05). 
      After the procedure, the patients showed no worsening of LVEF compared with 
      baseline (64%+/-5.3%), and no cases of bundle branch block nor complete heart block 
      occurred. CONCLUSIONS: ERFA guided by TTE provides a new treatment option for 
      HOCM which can achieve symptomatic improvement as well as a significant and 
      sustained reduction of the LVOT gradient. Moreover, by avoiding the use of the 3D 
      electroanatomical system or ICE, this treatment has an acceptable cost.
CI  - 2021 Annals of Translational Medicine. All rights reserved.
FAU - Kong, Lingqiu
AU  - Kong L
AD  - Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai, 
      China.
FAU - Zhao, Yongchao
AU  - Zhao Y
AD  - Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai, 
      China.
FAU - Pan, Hongwei
AU  - Pan H
AD  - Department of Cardiology, People's Hospital of Hunan Province, Changsha, China.
FAU - Ma, Jianying
AU  - Ma J
AD  - Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai, 
      China.
FAU - Qian, Juying
AU  - Qian J
AD  - Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai, 
      China.
FAU - Ge, Junbo
AU  - Ge J
AD  - Department of Cardiology, Zhongshan Hospital of Fudan University, Shanghai, 
      China.
LA  - eng
PT  - Journal Article
PL  - China
TA  - Ann Transl Med
JT  - Annals of translational medicine
JID - 101617978
PMC - PMC8267310
OTO - NOTNLM
OT  - Radiofrequency ablation
OT  - echocardiography
OT  - hypertrophic obstructive cardiomyopathy (HOCM)
OT  - left ventricular outflow tract (LVOT)
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at https://dx.doi.org/10.21037/atm-21-2783). The authors have no 
      conflicts of interest to declare.
EDAT- 2021/07/20 06:00
MHDA- 2021/07/20 06:01
PMCR- 2021/06/01
CRDT- 2021/07/19 06:01
PHST- 2021/04/14 00:00 [received]
PHST- 2021/06/16 00:00 [accepted]
PHST- 2021/07/19 06:01 [entrez]
PHST- 2021/07/20 06:00 [pubmed]
PHST- 2021/07/20 06:01 [medline]
PHST- 2021/06/01 00:00 [pmc-release]
AID - atm-09-12-1006 [pii]
AID - 10.21037/atm-21-2783 [doi]
PST - ppublish
SO  - Ann Transl Med. 2021 Jun;9(12):1006. doi: 10.21037/atm-21-2783.