Effect Analasis On Transcatheter Septal Radiofrequency Ablation Guided By Intracardiac Echocardiography In The Treatment Of Hypertrophic Obstructive Cardiomyopathy

BackgroundHypertrophic obstructive cardiomyopathy(HOCM)is currently considered to be a genetic mutation or genetic-related disease characterized by interventricular septum or ventricular wall hypertrophy.More than 75% of patients may develop left ventricular outflow tract obstruction(LVOTO)at rest or excitation,which is the main cause of heart failure or death.For patients who still have severe clinical symptoms after drug treatment,the main treatments recommended by major guidelines are Septal Myectomy(SM)and alcohol septal ablation(ASA).However,SM has great trauma and high mortality,and the efficacy of ASA is uncertain and there are many postoperative complications,so there is an urgent need for new alternative therapy in clinic,and radiofrequency catheter ablation(RFCA)of interventricular septum guided by intracardiac echocardiography(ICE)is one of them,but its curative effect is not clear.The purpose of this study was to evaluate the safety and efficacy of RFCA of interventricular septum under the guidance of ICE in the treatment of HOCM.ObjectiveThe study aims to evaluate the safety and effectiveness of interventricular septal RFCA under the guidance of ICE for people with HOCM of New York Heart Function(NYHA)grade Ⅲ or Ⅳ by comparing with traditional drug therapy.MethodsThis is a prospective,real-world,observational study.72 patients with HOCM hospitalized in Department of Cardiology of Zhengzhou Seventh People’s Hospital from February 2019 to December 2019 were selected according to the strict inclusion and exclusion criteria.32 patients were treated with RFCA of interventricular septum under the guidance of ICE,and 40 patients were treated with drugs therapy.The baseline period,perioperative period,3-month follow-up and 9-month follow-up were collected to compare the difference between the two treatments,and to evaluate the safety and effectiveness of interventricular septal RFCA under the guidance of ICE for people with HOCM ResultsFirst,at baseline,there was no significant difference between the two groups in the following items which include age,gender,average years of onset,previous alcohol septal ablation(ASA),clinical symptoms,major concomitant diseases,Interventricular Septum(IVS),1eft ventricular outflow tract gradient(LVOTG),Left ventricular end diastolic dimension(LVD d),Mitral Regurgitation areas(MR areas),Left Atrial Diameter(LAD),6-minute walk test,NYHA grade and previous medication but there were significant differences in LVOTG,Kansas City Cardiomyopathy Questionnaire(KCCQ)and Minnesota Living with Heart Failure Questionnaire(MLHFQ).Second,at 3-month follow-up,KCCQ score of RFCA group were higher than baseline,LVOTG,MR areas,MLHFQ scores were lower than baseline(P < 0.05),but the data of drug group had little change compared with baseline.At the 9-month follow-up,the follow-up results showed that the data of the two groups were similar to those at the baseline and 3-month follow-up;the difference was that at the 9-month follow-up,the 6-minute walking distance and KCCQ score of the RFCA group were further increased(P < 0.05).In the drug treatment group,the difference didn’t reach the statistical standard between the baseline,3-month follow-up and 9-month follow-up.With regard to comparison of two groups of endpoint events,the RFCA group was better than the drug group in terms of LVOTG≤50mm Hg or reduction≥50%[28(87.5%)vs.3(7.5%),P<0.05];There were more patients with NYHA class I-II in RFCA group than in drug group[24(75.0%)vs.7(17.5%)];there was no recurrence of syncope in the RFCA group,but there were 5(12.5%)syncope events in the drug group(P=0.108).In RFCA group,3(9.3%)patients were readmitted during the follow-up period compared to 17(42.5%)patients in the drug group(P=0.002);there was one death case in drug group,which was not statistically significant.ConclusionRFCA of interventricular septum under the guidance of ICE can reduce the left ventricular outflow tract pressure,improve the symptoms and the quality of life of patients with HOCM,it does not increase the risk of conduction block,has no permanent complications,which means much more safety.