Comparison of Percutaneous Endocardial Septal Radiofrequency Ablation with Alcohol Septal Ablation in Treating Hypertrophic Obstructive Cardiomyopathy.

Background: Alcohol septal ablation (ASA) and percutaneous endocardial septal radiofrequency ablation (PESA) are two mini-invasive interventions for treatment of hypertrophic obstructive cardiomyopathy (HOCM). Studies comparing the PESA and ASA remain scant.

Methods: We analyzed patients with HOCM who underwent PESA or ASA at our hospital between January 2008 and December 2023. A total of 145 patients were enrolled, with 37 receiving PESA and 108 receiving ASA.

Results: Compared to the ASA group, patients in the PESA group were older (p = 0.001), but suffered from less severer heart failure (p < 0.001). Patients in the ASA group were more likely to develop new bundle branch block (BBB), and stayed much longer at intensive care unit, but took less medical care cost. During the follow-up, there were no significant differences in rates of repeat septal reduction therapy (SRT) and the composite endpoint of repeat SRT and re-hospitalization between the two groups. Both PESA and ASA significantly alleviated heart failure, septal hypertrophy, and left ventricular outflow tract (LVOT) obstruction. However, ASA led to greater reduction in NYHA functional class (-1.4 ± 0.9 vs -0.7 ± 0.8, p < 0.001) , septal thickness (-4.5 ± 4.1mm vs -2.1 ± 4.1mm, p = 0.012), and the LVOTG (-51.1 ± 43.7 vs -23.0 ± 35.1 mmHg, p = 0.004) compare to PESA.

Conclusions: Both ASA and PESA are viable strategies for septal reduction in HOCM. ASA seems to be more effective in achieving significant anatomical and functional improvements, while PESA is excellent in avoiding BBB.