Percutaneous radiofrequency septal reduction for hypertrophic obstructive cardiomyopathy in children.

Abstract

OBJECTIVES:

The aim of this study was to assess the efficacy of radiofrequency catheter ablation (RFCA) in the treatment of hypertrophic obstructive cardiomyopathy in children.

BACKGROUND:

Hypertrophic obstructive cardiomyopathy is an uncommon cause of left ventricular outflow tract obstruction in children. In symptomatic patients, open heart surgical myectomy has hitherto been the only therapeutic option.

METHODS:

In 32 children, at a median age of 11.1 (range 2.9 to 17.5) years and weight of 31 (15 to 68) kg, ablation of the hypertrophied septum was performed using a cool-tip ablation catheter via a femoral arterial approach. The median number of lesions was 27 (10 to 63) and fluoroscopic time was 24 (12 to 60) min.

RESULTS:

The majority of patients demonstrated an immediate decrease in the catheter pullback gradient (mean 78.5 ± 26.2 mm Hg pre-RFCA versus mean 36.1 ± 16.5 mm Hg post-RFCA, p < 0.01) and a further reduction in the Doppler echocardiographic gradient (mean 96.9 ± 27.0 mm Hg pre-RFCA versus 32.7 ± 27.1 mm Hg post-RFCA, p < 0.01) at follow-up. One patient died due to a paradoxical increase in left ventricular outflow tract obstruction, and another had persistent atrioventricular block that required permanent pacing. Six patients required further procedures (surgery, pacing, or further RFCA) during a median follow-up of 48 (3 to 144) months.

CONCLUSIONS:

The preliminary results of RFCA for septal reduction in children with hypertrophic cardiomyopathy are promising and merit further evaluation.

• Authors: Narayanswami Sreeram, Mathias Emmel, Joseph V de Giovanni
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 58 Issue 24 Pg. 2501-10 (Dec 06 2011) ISSN: 1558-3597 [Electronic] United States
• PMID: 22133850 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Cardiac Pacing, Artificial
• Cardiomyopathy, Hypertrophic (diagnostic imaging, physiopathology, surgery)
• Catheter Ablation
• Child
• Child, Preschool
• Coronary Angiography
• Echocardiography, Doppler
• Echocardiography, Transesophageal
• Female
• Heart Conduction System (physiopathology)
• Humans
• Male