Percutaneous Radiofrequency Septal Reduction for Hypertrophic Obstructive Cardiomyopathy in Children

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. (J Am Coll Cardiol 2011;58:2501-10) (C) 2011 by the American College of Cardiology Foundation