Efficacy and safety of myectomy and radiofrequency septal ablation for treating hypertrophic obstructive cardiomyopathy

Abstract

Background Novel treatments are needed for patients with severely symptomatic obstructive hypertrophic cardiomyopathy (oHCM). Radiofrequency (RF) septal ablation has emerged as a promising technique for improving the left ventricular outflow tract (LVOT) gradient and alleviating symptoms, potentially achieving outcomes comparable to the gold-standard surgical myectomy. Objectives To compare the 1-year efficacy and safety of surgical myectomy with RF septal ablation in patients with oHCM. Methods This observational, retrospective cohort study included patients aged≥18 years with oHCM and an LVOT gradient≥50 mm Hg, unresponsive to medical therapy, who underwent surgical myectomy or RF septal ablation between 2012 and 2022. Results The mean age was 49.8±14 and 56.9±10.9 years for the myectomy and RF groups, respectively, with the same sex distribution. The proportions of patients in functional class III distributions were 54.5% and 76.1% in the myectomy and RF groups, respectively. The LVOT gradient was 108.6±49.8 and 101.1±40.3 mm Hg for the myectomy and RF groups, respectively. Procedural success, defined as a reduction in the LVOT gradient to <50 mm Hg or an improvement to functional class I or II, showed no significant difference between the groups (HR: -3.5; 95% CI: -20.2 to 13.12; p=0.673). Complications occurred in 57.6% and 4.6% of the patients in the myectomy and RF groups, respectively (p<0.001). Conclusions RF septal ablation and surgical myectomy demonstrated similar efficacy in reducing LVOT gradients and improving symptoms. However, RF ablation exhibited a superior safety profile.