Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Clin Cardiol. 2020 May;43(5):450-458. doi: 10.1002/clc.23341. Epub 2020 Feb 7.
Although radiofrequency ablation is widely used in the treatment of arrhythmias, its role in septal reduction therapy of hypertrophic obstructive cardiomyopathy (HOCM) is unclear. This meta-analysis aimed to assess the efficacy and safety of radiofrequency septal ablation for HOCM.
Radiofrequency septal ablation is effective and safe for relieving obstruction and improving exercise capacity in patients with HOCM.
A systematic review of eligible studies that reported outcomes of patients with HOCM who underwent radiofrequency septal ablation was performed using PubMed, Embase, Cochrane, ProQuest, Scopus, ScienceDirect, and Web of Science database. Pooled estimates were calculated using random-effects meta-analysis. Methodological quality was assessed using the Newcastle-Ottawa scale. Publication bias and sensitivity analyses were also performed.
Eight studies with 91 patients (mean follow-up 11.6 months) were included. The left ventricular outflow tract (LVOT) gradient at rest decreased significantly after radiofrequency septal ablation (pooled reduction: -58.8 mmHg; 95% confidence interval [CI] -64.3 to -53.5). A reduction was also found in the provoked LVOT gradient with a pooled reduction of -97.6 mmHg (95% CI: -124.4 to -87.1). An improvement of the New York Heart Association classification (mean: -1.4; 95% CI: -1.6 to -1.2) was found during follow-up. The change in septal thickness was minimal and not statistically significant. Two procedure-related deaths were documented, and complete heart block occurred in eight patients.
Radiofrequency septal ablation is effective and safe for relieving LVOT obstruction and improving exercise capacity in patients with HOCM.
尽管射频消融术在心律失常的治疗中得到广泛应用，但它在肥厚型梗阻性心肌病（HOCM）的间隔缩减治疗中的作用尚不清楚。本荟萃分析旨在评估射频间隔消融术治疗 HOCM 的疗效和安全性。
射频间隔消融术对于缓解 HOCM 患者的梗阻并改善其运动能力是有效且安全的。
通过检索 PubMed、Embase、Cochrane、ProQuest、Scopus、ScienceDirect 和 Web of Science 数据库，对报道接受射频间隔消融术的 HOCM 患者结局的合格研究进行系统评价。使用随机效应荟萃分析计算汇总估计值。采用纽卡斯尔-渥太华量表评估方法学质量，并进行发表偏倚和敏感性分析。
纳入 8 项研究共 91 例患者（平均随访 11.6 个月）。射频间隔消融术后左心室流出道（LVOT）梯度在休息时显著降低（汇总降低：-58.8mmHg；95%置信区间[CI]：-64.3 至 -53.5）。在诱发的 LVOT 梯度中也发现了降低，汇总降低为-97.6mmHg（95%CI：-124.4 至 -87.1）。在随访期间，纽约心脏协会（NYHA）心功能分级也得到改善（平均：-1.4；95%CI：-1.6 至 -1.2）。间隔厚度的变化很小，且无统计学意义。记录了 2 例与手术相关的死亡病例，8 例患者发生完全性心脏阻滞。
射频间隔消融术对于缓解 HOCM 患者的 LVOT 梗阻和改善运动能力是有效且安全的。
