Abstract
BACKGROUND: Many patients with drug-refractory hypertrophic obstructive cardiomyopathy (HOCM) decline or are ineligible for surgical myectomy or alcohol septal ablation. Although conventional unipolar percutaneous endocardial septal radiofrequency ablation is a minimally invasive alternative, its limited lesion depth yields only modest left ventricular outflow tract gradient (LVOTG) relief. Bipolar radiofrequency catheter ablation creates deeper lesions in the treatment of ventricular arrhythmias; however, its role in HOCM remains unreported. FIRST-IN-HUMAN/EARLY REPORTS SUMMARY: We present the first in-human case of combined bipolar ablation and percutaneous endocardial septal radiofrequency ablation (Bi-PESA) in an older patient with drug-refractory HOCM. Ultimately, the patient experienced significant reduction in the LVOTG, translating to significant symptomatic improvement. DISCUSSION: This case suggests Bi-PESA could be a novel, effective, and safe septal reduction option for patients with drug-refractory HOCM. NOVELTY: To our knowledge, this is the first-in-human report of Bi-PESA for HOCM to reduce LVOTG and improve symptoms. TAKE-HOME MESSAGE: Bi-PESA may offer a feasible and potentially preferable alternative for patients with HOCM who decline or are ineligible for surgical myectomy or alcohol septal ablation.