Patients with obstructive hypertrophic cardiomyopathy (HOCM) and drug-refractory symptoms have limited nonsurgical treatment options. Percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) has previously been investigated as a nonsurgical treatment of HOCM.

This animation and additional live case show the steps to perform the novel PIMSRA procedure. Under real-time echocardiographic guidance, a radiofrequency electrode needle is inserted into the interventricular septum via a percutaneous transapical intramyocardial approach. High-frequency alternating current is applied, resulting in irreversible coagulation necrosis of the tissue and regional blood vessels. Basal and mid portions of anterior and posterior septum can be targeted to ensure efficacy. Contrast echocardiography is performed to assess the ablation region, and a comprehensive Doppler assessment is performed to assess hemodynamic improvement.

In a single-arm study of 200 consecutive patients with symptomatic HOCM despite medical therapy, PIMSRA resulted in a durable reduction in peak left ventricular outflow tract gradients, associated with a significant improvement in symptoms at medium-term follow-up, with low morbidity and mortality.

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