Endocardial radiofrequency ablation of septal hypertrophy in the interventional treatment of the hypertrophic obstructive cardiomyopathy; comparison with the alcohol septal ablation, pilot data of the randomized trial

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00159816%3A_____%2F25%3A00082247" target="_blank" >RIV/00159816:_____/25:00082247 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00216224:14110/25:00142522

Výsledek na webu

<a href="https://e-coretvasa.cz/artkey/cor-202505-0004_endocardial-radiofrequency-ablation-of-septal-hypertrophy-in-the-interventional-treatment-of-the-hypertrophic-o.php" target="_blank" >https://e-coretvasa.cz/artkey/cor-202505-0004_endocardial-radiofrequency-ablation-of-septal-hypertrophy-in-the-interventional-treatment-of-the-hypertrophic-o.php</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.33678/cor.2025.101" target="_blank" >10.33678/cor.2025.101</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Endocardial radiofrequency ablation of septal hypertrophy in the interventional treatment of the hypertrophic obstructive cardiomyopathy; comparison with the alcohol septal ablation, pilot data of the randomized trial

Popis výsledku v původním jazyce

Introduction: Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by dynamic left ventricular outflow tract (LVOT) obstruction due to asymmetric septal hypertrophy and systolic anterior motion (SAM) of the mitral valve. In patients with persistent symptoms despite optimized medical therapy, septal reduction therapy is indicated. While alcohol septal ablation (ASA) is a well-established catheter-based treatment, endocardial radiofrequency ablation of septal hypertrophy (ERASH) has recently emerged as a promising alternative. Aim of our study is to report the pilot data of the randomized study comparing efficacy and safety of ERASH versus ASA. Methods: This single-center, prospective, randomized pilot study compared the efficacy and safety of ERASH versus ASA in symptomatic patients with obstructive HOCM refractory to medical therapy. ERASH procedure is catheter radiofrequency ablation of septal hypertrophy using contact force-sensing irrigated ablation catheters guided by 3D electroanatomical mapping with use of intracardiac echocardiography. ASA is based on injection of 96% alcohol into the septal branch of the left coronary artery to induce a small, controlled infarction of the hypertrophic septum and consequently abolishes the dynamic outflow obstruction. LVOT gradients were measured invasively at baseline and immediately post-procedure, and patients were followed at 3, 6, and 12 months for clinical and echocardiographic reassessment. Results: Nineteen patients were randomized to undergo ERASH (n = 10) or ASA (n = 9) from May 2021 to February 2023. Procedural duration was significantly longer in the ERASH group (median 180 vs. 30 minutes, p &lt;0.001), while fluoroscopy time and dose (6,24 min/11000 mGy/cm2 ERASH group vs 7,18 min/11151 mGy/cm2 ASA group, p = 0.391/0,967) were comparable. Both groups achieved substantial immediate reductions in LVOT gradients. In the ERASH group, resting LVOT gradient decreased from a median of 103 mmHg to 22.5 mmHg, and provocable gradient from 205 mmHg to 67 mmHg. In the ASA group, resting gradient decreased from 72 mmHg to 20 mmHg, and provocable gradient from 155 mmHg to 54.5 mmHg. At 12-month follow-up, resting gradients remained low (17.5 mmHg in ERASH vs. 15.5 mmHg in ASA), and NYHA functional class improved to 2.25 and 1.75, respectively. ERASH patients showed a greater improvement in 6-minute walk distance (395.9 m vs. 311.9 m, p = 0.264). Periprocedural complications were more frequent in the ERASH group, including two pericardial effusions and one permanent arioventricular (AV) block, mostly occurring in patients with pre-existing conduction disorders. Conclusion: In this randomized pilot study, ERASH demonstrated comparable clinical and hemodynamic efficacy to ASA in reducing LVOT gradients and improving symptoms. While the complication rate was higher with ERASH, it may reflect procedural learning curve and baseline patient risk. ERASH may offer an alternative in patients with unsuitable coronary anatomy or different contraindications to ASA. Larger studies are needed to confirm these results and optimize patient selection.

Název v anglickém jazyce

Endocardial radiofrequency ablation of septal hypertrophy in the interventional treatment of the hypertrophic obstructive cardiomyopathy; comparison with the alcohol septal ablation, pilot data of the randomized trial

Popis výsledku anglicky

Introduction: Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by dynamic left ventricular outflow tract (LVOT) obstruction due to asymmetric septal hypertrophy and systolic anterior motion (SAM) of the mitral valve. In patients with persistent symptoms despite optimized medical therapy, septal reduction therapy is indicated. While alcohol septal ablation (ASA) is a well-established catheter-based treatment, endocardial radiofrequency ablation of septal hypertrophy (ERASH) has recently emerged as a promising alternative. Aim of our study is to report the pilot data of the randomized study comparing efficacy and safety of ERASH versus ASA. Methods: This single-center, prospective, randomized pilot study compared the efficacy and safety of ERASH versus ASA in symptomatic patients with obstructive HOCM refractory to medical therapy. ERASH procedure is catheter radiofrequency ablation of septal hypertrophy using contact force-sensing irrigated ablation catheters guided by 3D electroanatomical mapping with use of intracardiac echocardiography. ASA is based on injection of 96% alcohol into the septal branch of the left coronary artery to induce a small, controlled infarction of the hypertrophic septum and consequently abolishes the dynamic outflow obstruction. LVOT gradients were measured invasively at baseline and immediately post-procedure, and patients were followed at 3, 6, and 12 months for clinical and echocardiographic reassessment. Results: Nineteen patients were randomized to undergo ERASH (n = 10) or ASA (n = 9) from May 2021 to February 2023. Procedural duration was significantly longer in the ERASH group (median 180 vs. 30 minutes, p &lt;0.001), while fluoroscopy time and dose (6,24 min/11000 mGy/cm2 ERASH group vs 7,18 min/11151 mGy/cm2 ASA group, p = 0.391/0,967) were comparable. Both groups achieved substantial immediate reductions in LVOT gradients. In the ERASH group, resting LVOT gradient decreased from a median of 103 mmHg to 22.5 mmHg, and provocable gradient from 205 mmHg to 67 mmHg. In the ASA group, resting gradient decreased from 72 mmHg to 20 mmHg, and provocable gradient from 155 mmHg to 54.5 mmHg. At 12-month follow-up, resting gradients remained low (17.5 mmHg in ERASH vs. 15.5 mmHg in ASA), and NYHA functional class improved to 2.25 and 1.75, respectively. ERASH patients showed a greater improvement in 6-minute walk distance (395.9 m vs. 311.9 m, p = 0.264). Periprocedural complications were more frequent in the ERASH group, including two pericardial effusions and one permanent arioventricular (AV) block, mostly occurring in patients with pre-existing conduction disorders. Conclusion: In this randomized pilot study, ERASH demonstrated comparable clinical and hemodynamic efficacy to ASA in reducing LVOT gradients and improving symptoms. While the complication rate was higher with ERASH, it may reflect procedural learning curve and baseline patient risk. ERASH may offer an alternative in patients with unsuitable coronary anatomy or different contraindications to ASA. Larger studies are needed to confirm these results and optimize patient selection.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

—

Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2025

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Cor et Vasa

ISSN

0010-8650

e-ISSN

1803-7712

Svazek periodika

67

Číslo periodika v rámci svazku

5

Stát vydavatele periodika

CZ - Česká republika

Počet stran výsledku

10

Strana od-do

561-570

Kód UT WoS článku

001618286800002

EID výsledku v databázi Scopus

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