Li Xi, Liu Tao, Cui Bo, Chen Yanhong, Tang Cheng, Wu Gang
Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, 430060 Wuhan, Hubei, China.
Department of Cardiology, Wuhan Asia General Hospital, 430060 Wuhan, Hubei, China.
Rev Cardiovasc Med. 2024 Jan 29;25(2):38. doi: 10.31083/j.rcm2502038. eCollection 2024 Feb.
Percutaneous radiofrequency catheter ablation (RFA) in hypertrophic obstructive cardiomyopathy (HOCM) with intracardiac echocardiography (ICE) guidance is a novel method that has been proven to be safe and effective in a small sample size study. RFA of the interventricular septum through a trans-atrial septal approach in HOCM patients with a longer follow-up has not been reported.
62 consecutive patients from March 2019 to February 2022 were included in this study. The area between the hypertrophied septum and anterior mitral valve (MV) leaflet was established using the three-dimensional system (CARTO 3 system), and all patients received atrial septal puncture under the guidance of intracardiac echocardiography (ICE). Point-by-point ablation was performed to cover the contact area. After ablation, the patients were followed up for 1, 3, 6, and 12 months. Transthoracic echocardiography was performed at 1, 3, 6, and 12 months, and resting and exercise-provoked left ventricular outflow tract (LVOT) gradients were obtained.
During the 1-year follow-up, most patients' symptoms improved. The NYHA grading of the patient decreased from 2 (2, 3) at baseline to 2 (1, 2) ( 0.001). LVOT peak gradient at rest was decreased from 59 ( 27) mmHg to 30 ( 24) mmHg ( 0.001), and the provoked peak gradient was decreased from 99 ( 33) mmHg to 59 ( 34) mmHg ( 0.001). The average maximum septal thickness was reduced from 21 ( 4) mm to 19 ( 4) mm ( 0.001).
After a 1-year follow-up, ice-guided radiofrequency ablation for HOCM might be a safe, accurate, and effective method. The catheter might be reliably attached to the ablation target area via trans-atrial septal access.
在心脏内超声心动图（ICE）引导下，经皮射频导管消融术（RFA）治疗肥厚性梗阻性心肌病（HOCM）是一种新方法，在一项小样本研究中已被证明安全有效。尚未有关于采用经房间隔途径对HOCM患者的室间隔进行RFA并进行长期随访的报道。
本研究纳入了2019年3月至2022年2月连续收治的62例患者。使用三维系统（CARTO 3系统）确定肥厚的室间隔与二尖瓣（MV）前叶之间的区域，所有患者均在心脏内超声心动图（ICE）引导下进行房间隔穿刺。进行逐点消融以覆盖接触区域。消融后，对患者进行1、3、6和12个月的随访。在1、3、6和12个月时进行经胸超声心动图检查，获取静息和运动诱发的左心室流出道（LVOT）梯度。
在1年的随访期间，大多数患者的症状有所改善。患者的纽约心脏协会（NYHA）分级从基线时的2（2，3）降至2（1，2）（<0.001）。静息时LVOT峰值梯度从59（±27）mmHg降至30（±24）mmHg（<0.001），诱发峰值梯度从99（±33）mmHg降至59（±34）mmHg（<0.001）。平均最大室间隔厚度从21（±4）mm降至19（±4）mm（<0.001）。
经过1年的随访，ICE引导下的RFA治疗HOCM可能是一种安全、准确且有效的方法。通过经房间隔途径，导管可能可靠地附着于消融目标区域。
