Abstract
Background
The definitive therapeutic options for symptomatic obstructive cardiomyopathy in childhood are restricted. At present, extensive surgical myectomy is the only procedure that is of proven benefit.
Patients and Methods
Three patients, aged 5, 11 and 17 years, respectively, with progressive hypertrophic obstructive cardiomyopathy and increasing symptoms were considered for radiofrequency catheter septal ablation. The peak Doppler gradient recorded on several occasions ranged between 50 to 90mmHg. Via a femoral arterial approach, the His bundle was initially plotted and marked using the LocaLisa navigation system. Subsequently, using a cooled tip catheter a series of lesions were placed in the hypertrophied septum, taking care to stay away from the His bundle. A total of 17, 50 and 45 lesions were applied in the three patients. In one case, the procedure was complicated by two episodes of ventricular fibrillation requiring DC cardioversion but without any neurological sequelae.
Results
The preablation peak-to-peak gradient between left ventricle and aorta was 50 mmHg, 60 mmHg and 60 mmHg, respectively, and remained unchanged immediately after the procedure. All patients were discharged from hospital 48 hours later. Serial measurement of serum troponin T and CK-MB isoenzyme confirmed significant myocardial necrosis. Follow-up echocardiography both at seven days and at six weeks postablation confirmed a beneficial haemodynamic result, with reduction of left ventricular outflow obstruction and relief of symptoms.
Conclusion
In young children, in whom alcohol-induced septal ablation is not an option, radiofrequency catheter ablation offers an alternative to surgery, with the benefits of repeatability and a lower risk of procedure-related permanent AV block.
Keywords: hypertrophic obstructive cardiomyopathy, radiofrequency catheter ablation, childhood
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- Autore Camillo, Spirito Paolo, Spirito Paolo. Approach to Hypertrophic Cardiomyopathy. Curr Treat Options Cardiovasc Med. 2004 Dec;6(6):489–498. doi: 10.1007/s11936-004-0006-7. [DOI] [PubMed] [Google Scholar]
- Dimitrow P. P., Dubiel J. S. Echocardiographic risk factors predisposing to sudden cardiac death in hypertrophic cardiomyopathy. Heart. 2005 Jan;91(1):93–94. doi: 10.1136/hrt.2003.030353. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hess Otto M., Sigwart Ulrich. New treatment strategies for hypertrophic obstructive cardiomyopathy: alcohol ablation of the septum: the new gold standard? J Am Coll Cardiol. 2004 Nov 16;44(10):2054–2055. doi: 10.1016/j.jacc.2004.08.047. [DOI] [PubMed] [Google Scholar]
- Lawrenz T., Kuhn H. Endocardial radiofrequency ablation of septal hypertrophy. A new catheter-based modality of gradient reduction in hypertrophic obstructive cardiomyopathy. Z Kardiol. 2004 Jun;93(6):493–499. doi: 10.1007/s00392-004-0097-x. [DOI] [PubMed] [Google Scholar]
- Maron Barry J., Casey Susan A., Hauser Robert G., Aeppli Dorothee M. Clinical course of hypertrophic cardiomyopathy with survival to advanced age. J Am Coll Cardiol. 2003 Sep 3;42(5):882–888. doi: 10.1016/s0735-1097(03)00855-6. [DOI] [PubMed] [Google Scholar]
- Maron Barry J., Dearani Joseph A., Ommen Steve R., Maron Martin S., Schaff Hartzell V., Gersh Bernard J., Nishimura Rick A. The case for surgery in obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol. 2004 Nov 16;44(10):2044–2053. doi: 10.1016/j.jacc.2004.04.063. [DOI] [PubMed] [Google Scholar]
- Maron Barry J. Hypertrophic cardiomyopathy in childhood. Pediatr Clin North Am. 2004 Oct;51(5):1305–1346. doi: 10.1016/j.pcl.2004.04.017. [DOI] [PubMed] [Google Scholar]
- Minakata Kenji, Dearani Joseph A., Nishimura Rick A., Maron Barry J., Danielson Gordon K. Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae. J Thorac Cardiovasc Surg. 2004 Feb;127(2):481–489. doi: 10.1016/j.jtcvs.2003.09.040. [DOI] [PubMed] [Google Scholar]
- Woo Anna, Williams William G., Choi Richard, Wigle E. Douglas, Rozenblyum Evelyn, Fedwick Katie, Siu Samuel, Ralph-Edwards Anthony, Rakowski Harry. Clinical and echocardiographic determinants of long-term survival after surgical myectomy in obstructive hypertrophic cardiomyopathy. Circulation. 2005 Apr 11;111(16):2033–2041. doi: 10.1161/01.CIR.0000162460.36735.71. [DOI] [PubMed] [Google Scholar]