Efficacy and Safety of Percutaneous Intramyocardial Septal Radiofrequency Ablation for Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-Analysis

Hypertrophic obstructive cardiomyopathy (HOCM) is a hereditary condition associated with heart failure and sudden death. Percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) has emerged as a novel treatment. However, the efficacy and safety of PIMSRA remain uncertain due to limited research. A comprehensive search on PubMed and Cochrane Central included studies on HOCM patients undergoing PIMSRA. Primary outcomes were resting and provoked left ventricular outflow tract (LVOT) gradients. Data analysis was conducted in RevMan (Version 5.4) using inverse variance with a random-effects model to aggregate mean differences (MDs) with 95% confidence intervals (CIs), and funnel plots assessed publication bias. Eight studies (2 clinical trials and 6 cohorts) with 492 patients (mean age: 46.6 ± 14.4 years) were included. PIMSRA significantly reduced the LVOT gradient at rest (MD: -64.21, 95% CI: -71.05 to 57.38; P < 0.00001, I2 = 96%) and provoked (MD: -83.02, 95% CI: -92.77 to -73.2, P < 0.00001, I2 = 96%). New York Heart Association functional class improved (MD: -1.31, 95% CI: -1.57 to -1.05, P < 0.00001) and septal size decreased (MD: -6.77, 95% CI: -7.92 to -5.62, P < 0.00001). Adverse events occurred in 10.5% of patients, with low rates of in-hospital and 30-day mortality (1%), minimal bleeding, and rare strokes. Subgroup analysis showed statistically significant reductions in both resting and provoked LVOT gradients across all follow-ups (immediate postprocedure till 5 years) post-PIMSRA, with sustained improvements. PIMSRA demonstrates significant efficacy in reducing LVOT gradients in HOCM patients. The procedure shows a favorable safety profile, making it a viable alternative to conventional interventions.