Myocardial bridge impacts septal radiofrequency ablation safety in hypertrophic obstructive cardiomyopathy
4 affiliations
- 1Department of Radiology, Fourth Military Medical University, Xi’an, Shaanxi, China
- 2Department of Cardiology, Fourth Military Medical University, Xi’an, Shaanxi, China
- 3Department of Health Statistics, Fourth Military Medical University, Xi’an, Shaanxi, China
- 4Department of Ultrasound, Fourth Military Medical University, Xi’an, Shaanxi, China
Abstract
Background: Up to 30% of patients with hypertrophic cardiomyopathy have the myocardial bridge (MB) mainly in the left anterior descending (LAD) coronary artery. Given the close anatomical proximity between percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) targets and the LAD, we investigated the impact of MB on the safety and efficacy of PIMSRA in hypertrophic obstructive cardiomyopathy (HOCM) patients.
Methods: This single-centre retrospective study enrolled HOCM patients who underwent PIMSRA between January 2020 and June 2021. Patients were divided into MB and non-MB groups based on preoperative coronary CT angiography (CCTA). Clinical, echocardiographic and CCTA characteristics were collected at baseline and 1 year after PIMSRA.
Results: 126 patients (mean age 45.11 years; 89 male) were included and 45 (35.7%, all localised to the LAD) had MB. New-onset angina occurred only in the MB group (13/45, 28.9%). Postoperatively, MB depth and systolic stenosis increased significantly (from 2.15±2.02 mm to 2.64±2.46 mm, median: 15.8%–17.1%, p<0.001), while MB length showed no significant change (p=0.286). Receiver operating characteristic curve analysis revealed that preoperative MB depth predicted new-onset angina (area under the curve=0.886, cut-off 2.7 mm). Left ventricular outflow tract pressure gradient and maximal septal thickness were significantly reduced from baseline in both cohorts (p<0.001).
Conclusion: MB does not affect PIMSRA efficacy but increases postoperative angina risk. Preoperative CCTA assessment of MB may identify high-risk patients and guide treatment.
Related
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BibTeX
@article{zhao2026myocardial,
title = {{Myocardial bridge impacts septal radiofrequency ablation safety in hypertrophic obstructive cardiomyopathy}},
author = {Hongliang Zhao and Jiaming Li and Xiubing Shi and Chao Gao and Lei Shang and Liwen Liu and Minwen Zheng},
journal = {Open Heart},
year = {2026},
month = oct,
doi = {10.1136/openhrt-2026-004397},
url = {https://doi.org/10.1136/openhrt-2026-004397},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Myocardial bridge impacts septal radiofrequency ablation safety in hypertrophic obstructive cardiomyopathy
AU - Hongliang Zhao
AU - Jiaming Li
AU - Xiubing Shi
AU - Chao Gao
AU - Lei Shang
AU - Liwen Liu
AU - Minwen Zheng
PY - 2026
DA - 2026/10/27
JO - Open Heart
DO - 10.1136/openhrt-2026-004397
UR - https://doi.org/10.1136/openhrt-2026-004397
AB - Background: Up to 30% of patients with hypertrophic cardiomyopathy have the myocardial bridge (MB) mainly in the left anterior descending (LAD) coronary artery. Given the close anatomical proximity between percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) targets and the LAD, we investigated the impact of MB on the safety and efficacy of PIMSRA in hypertrophic obstructive cardiomyopathy (HOCM) patients. Methods: This single-centre retrospective study enrolled HOCM patients who underwent PIMSRA between January 2020 and June 2021. Patients were divided into MB and non-MB groups based on preoperative coronary CT angiography (CCTA). Clinical, echocardiographic and CCTA characteristics were collected at baseline and 1 year after PIMSRA. Results: 126 patients (mean age 45.11 years; 89 male) were included and 45 (35.7%, all localised to the LAD) had MB. New-onset angina occurred only in the MB group (13/45, 28.9%). Postoperatively, MB depth and systolic stenosis increased significantly (from 2.15±2.02 mm to 2.64±2.46 mm, median: 15.8%–17.1%, p<0.001), while MB length showed no significant change (p=0.286). Receiver operating characteristic curve analysis revealed that preoperative MB depth predicted new-onset angina (area under the curve=0.886, cut-off 2.7 mm). Left ventricular outflow tract pressure gradient and maximal septal thickness were significantly reduced from baseline in both cohorts (p<0.001). Conclusion: MB does not affect PIMSRA efficacy but increases postoperative angina risk. Preoperative CCTA assessment of MB may identify high-risk patients and guide treatment.
SN - 2053-3624
ER -