Endocardial radiofrequency ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy: A review of literature and comment on risks

Author(s): Dennis Lawin, Christoph Stellbrink, Kristin Marx, Thorsten Lawrenz

Endocardial Radiofrequency Ablation of Septal Hypertrophy (ERASH) has been developed for patients suffering from Hypertrophic Obstructive Cardiomyopathy (HOCM) who are not eligible for Septal Myectomy (SM) or Alcohol Septal Ablation (ASA).

The existing data regarding clinical outcomes of ERASH is scarce. Therefore, we reviewed the literature on acute and long-term outcomes of ERASH with focus on potential procedure-related risks and complications.

In the published studies ERASH effectively reduced the LVOTG and improved diseaserelated symptoms in acute and chronic follow-up. 17.1% of the overall 99 reported patients had a procedure-related high-degree AV block. A paradoxical increase in obstruction, a life-threatening complication, occurred in 7.1% of the patients treated with ERASH. It was associated with progressive obstruction of the left ventricular outflow tract and mitral regurgitation due to pronounced systolic anterior movement of the anterior mitral valve leaflet. PIO led to death in 2 patients.

In conclusion, ERASH is feasible and effective for the treatment of patients with HOCM irrespective of the underlying coronary anatomy. However, the incidence of complications in the published studies was higher compared to ASA and SM and, thus, ERASH should only be applied to those patients who are not suitable for ASA and SM.