Efficacy And Safety Of Radiofrequency Septal Ablation And Alcohol Ablation For Hypertrophic Obstructive Cardiomyopathy:Meta-analysis

Background:Hypertrophic cardiomyopathy is a myocardial disease of autosomal dominant inheritance.About 1/4 of HCM patients have obvious left ventricular outflow tract obstruction,and the incidence of sudden death is about 1%,which is the common cause of sudden death in adolescents.Interventional therapy has become the main treatment for hypertrophic obstructive cardiomyopathy with the advantages of less trauma,quick recovery,and fewer complications,including radiofrequency septal ablation and septal alcohol ablation.However,there is little comprehensive evaluation of the two procedures.In this paper,the efficacy and safety of the two ablation methods were compared by systematic analysis of published literature,providing reliable reference for clinical practice.Objective:A meta-analysis was conducted to evaluate the efficacy and safety of radiofrequency septal ablation and alcohol ablation in patients with hypertrophic obstructive cardiomyopathy,to provide evidence-based medical evidence for the choice of surgical ablation for patients with hypertrophic obstructive cardiomyopathy.Methods:After establishing the inclusion and exclusion criteria,Related studies were searched in Pub Med,Embase,Cochrane Library,CNKI,Wanfang Database,VIP,etc.,through the retrieval database using the combination of subject words,free words retrieval strategy,at the same time combined with manual retrieval methods.All studies related to alcohol septal ablation and radiofrequency ablation were searched from various databases in the last ten years.According to the exclusion criteria,the retrieved results were screened.Outcome indicators were extracted from the included studies,effectiveness indicators included LVOTPG,IVS,and LVEF,safety indicators included perioperative death,ventricular arrhythmia,and permanent pacemaker implantation.MINORS entries was used to assess the study quality,based on whether the study purpose was defined,the consistency of the patients enrolled,the collection of expected data,whether the endpoints appropriately reflect the study purpose,the objectivity of the endpoints evaluation,whether the follow-up time was adequate,the loss of follow-up rate was less than 5%,and whether the sample size was estimated,etc.Finally,meta-analysis was performed on the experimental data in the selected studies by using Rev Man5.4.Result:A total of 2228 related studies were retrieved.According to the inclusion and exclusion criteria,62 studies were finally included,including 15 studies on radiofrequency ablation,involving 278 cases,and 47 studies on alcohol septal ablation,involving 7801 cases.The results of meta-analysis suggest that in effectiveness indicators:LVOTG（MD=61.62,95%CI[47.95,75.28],P<0.05）,LVOTG（MD=54.12,95%CI[49.21,5902],P<0.05）,comparison of the two group（Chi~2=1.03,P=0.31）;IVS（MD=3.95,95%CI[1.41,6.49],PP<0.05）and IVS（MD=5.09,95%CI[4.36,5.82],P<0.05）,comparison of the two group（Chi~2=0.72,P=0.40）;LVEF（MD=2.06,95%CI[-1.47,5.58],P=0.25）and LVEF（MD=4.45,95%CI[2.80,6.11], P<0.05）,comparison of the two group（Chi~2=1.45,P=0.23）;In terms of safety indicators,the number of permanent pacemakers implanted after ASA and radiofrequency ablation（RR=0.66,95%CI[0.32,1.36],P=0.26）;The number of ventricular tachycardia and ventricular fibrillation during operation（RR=0.86,95%CI[0.21,3.56],P=0.83）;Perioperativemortality（RR=2.36,95%CI[0.74,7.48],P=0.14）.Conclusion:Radiofrequency ablation and alcohol ablation can effectively relieve left ventricular outflow tract obstruction and improve clinical symptoms in HOCM patients.There was no significant difference in efficacy and safety between the two methods.