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Selective Interventricular Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy: Who can benefit?
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  • QIANG LIU,
  • Hangyuan Qiu,
  • Ru-hong Jiang,
  • Xiaomei Tang,
  • Wenpu Guo,
  • Kuangshi Zhou,
  • Qiufan Chen,
  • Ya-xun Sun,
  • Lu Yu,
  • Shi-quan Chen,
  • Pei Zhang,
  • Xia Sheng,
  • Jun Zhu,
  • JIANWEI LIN,
  • Hui Cheng,
  • Yunhe Wang,
  • Bei Wang,
  • Chan Yu,
  • Yankai Mao,
  • Juhong Zhang,
  • Zu-wen Zhang,
  • Paul Zei,
  • Guo-sheng Fu,
  • Chen-Yang Jiang
QIANG LIU
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Hangyuan Qiu
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Ru-hong Jiang
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Xiaomei Tang
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Wenpu Guo
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Kuangshi Zhou
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Qiufan Chen
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Ya-xun Sun
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Lu Yu
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Shi-quan Chen
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Pei Zhang
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Xia Sheng
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Jun Zhu
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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JIANWEI LIN
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Hui Cheng
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Yunhe Wang
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Bei Wang
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Chan Yu
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Yankai Mao
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Juhong Zhang
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Zu-wen Zhang
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Paul Zei
Brigham and Women's Hospital Department of Medicine
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Guo-sheng Fu
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Chen-Yang Jiang
Zhejiang University School of Medicine Sir Run Run Shaw Hospital
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Abstract

Introduction: Septal mass reduction is beneficial for hypertrophic obstructive cardiomyopathy (HOCM) patients with severe left ventricular outflow (LVOT) gradient and symptoms, with surgical myectomy or alcohol septal ablation (ASA) currently recommended in selected patients. Radiofrequency (RF) ablation of hypertrophied septum has been published as a novel method to alleviate LVOT obstruction in small populations. This study aims to investigate factors influencing clinical outcomes of radiofrequency septum ablation. Methods and results: In this study, twenty patients with HOCM who underwent endocardial ablation were included. Echocardiography and cardiac MRI (CMR) data was collected and analyzed pre- and (or) post- procedure. Nineteen patients underwent ablation successfully, while ablation was aborted in one patient with prior RBBB due to transient complete atrioventricular block (AVB). After six months of follow-up, NYHA heart functional class improved from III (2 - 3) to II (1 - 2) (p < 0.001), and resting LVOT gradient was significantly reduced (87.6 ± 29.5 mmHg vs. 48.1 ± 29.7, p < 0.001). LVOT gradient reduction was significantly higher in patients with limited basal septal hypertrophy (60.9 ± 8.3 vs. 27.9 ± 7.1, p = 0.01), shorter anterior mitral leaflet (56.1 ± 6.4 vs. 20.4 ± 5.0, p<0.01) and normally positioned papillary muscle (36.9 ± 7.1 vs. 75.0 ± 6.3, p <0.05). Conclusions: Endocardial septal ablation appears to be a safe and effective procedure for alleviating LVOT gradient in patients with HOCM, especially in those with limited basal septal hypertrophy, shorter anterior mitral leaflet and normal positioned papillary muscle.