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. 2022 Apr 26:9:859205.
doi: 10.3389/fsurg.2022.859205. eCollection 2022.

Endocardial Radiofrequency Ablation vs. Septal Myectomy in Patients With Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-Analysis

Tao Jiang  1 , Bingyu Huang  1 , Shengqi Huo  1 , Lulu Monica Mageta  1 , Junyi Guo  1 , Jiagao Lv  1 , Li Lin  1
Affiliations

Endocardial Radiofrequency Ablation vs. Septal Myectomy in Patients With Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-Analysis

Tao Jiang et al. Front Surg. .

Abstract

Background: Septal myectomy (SM) has been the gold standard therapy for most patients with hypertrophic obstructive cardiomyopathy (HOCM). Endocardial radiofrequency ablation of septal hypertrophy (ERASH) is a novel treatment for septal reduction. We aimed to assess the efficacy and safety between two treatment strategies.

Methods: We searched PubMed, Web of Science, Cochrane Library, and Embase databases to identify relevant studies published up to March 2021. Random-effect models were used to calculate standardized mean difference (SMD) and 95% confidence intervals (CIs) for resting left ventricular outflow tract gradient (LVOTG) and septal thickness.

Results: Twenty-five studies are included in this review, eighteen studies for SM and seven studies for ERASH. During follow-up, there were significant reductions of the mean resting LVOTG in adults (SM groups: SMD = -3.03, 95% CI [-3.62 to -2.44]; ERASH groups: SMD = -1.95, 95% CI [-2.45 to -1.45]) and children (SM groups: SMD = -2.67, 95% CI [-3.21 to -2.12]; ERASH groups: SMD= -2.37, 95% CI [-3.02 to -1.73]) after the septal reduction therapies. For adults, SM groups contributed to more obvious reduction than ERASH groups in interventricular septal thickness (SM groups: SMD = -1.82, 95% CI [-2.29 to -1.34]; ERASH groups: SMD = -0.43, 95% CI [-1.00 to 0.13]). The improvement of the New York Heart Association class was similar in the two groups (SM groups: 46.4%; ERASH groups: 46.7%). The periprocedural mortality in SM and ERASH were 1.1 and 1.8%, respectively.

Conclusions: This systematic review suggests that SM is superior to ERASH in the treatment of HOCM. But for the patients who are at risk for open cardiac surgeries or prefer a less invasive approach, ERASH might be an optional approach.

Keywords: endocardial radiofrequency ablation; hypertrophic obstructive cardiomyopathy; meta-analysis; septal myectomy; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study selection process. ERASH, endocardial radiofrequency ablation of septal hypertrophy; SM, septal myectomy.
Figure 2
Figure 2
Forest plots for the primary outcomes in adults after septal myectomy or endocardial radiofrequency ablation. (A) Forest plot for the resting LVOTG. (B) Forest plot for the interventricular septal thickness. LVOTG, left ventricular outflow tract gradient.
Figure 3
Figure 3
Forest plot for the resting LVOTG in children after septal myectomy or endocardial radiofrequency ablation. LVOTG, left ventricular outflow tract gradient.
Figure 4
Figure 4
Funnel plots for publication bias. (A,B) Funnel plots for the resting LVOTG in adult-SM groups (A) and adult-ERASH groups (B). (C,D) Funnel plots for the interventricular septal thickness in adult-SM groups (C) and adult-ERASH groups (D). (E) Funnel plot for the resting LVOTG in children-SM groups. ERASH, endocardial radiofrequency ablation of septal hypertrophy; LVOTG, left ventricular outflow tract gradient; SM, septal myectomy; SMD, standardized mean difference.
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