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This retrospective study compared two treatments for obstructive hypertrophic cardiomyopathy in 211 patients: the Liwen procedure (a less invasive radiofrequency ablation) and modified Morrow myectomy (surgical removal of heart tissue). While traditional surgery achieved better reduction of left ventricular outflow tract obstruction at one year (gradient of 1.3 vs 16.1 mmHg), the Liwen procedure resulted in significantly fewer cardiac conduction problems (5% vs 62%), no permanent pacemaker requirements, shorter procedure time (80 vs 185 minutes), and reduced hospital stays (11 vs 16 days). Both methods successfully reduced gradients below 30 mmHg in most patients with similar serious adverse event rates.
Why it matters
This comparison reveals an important clinical tradeoff between more complete symptom relief and lower risk of conduction system damage requiring pacemakers. The findings may help cardiologists and patients make more informed treatment decisions based on individual risk profiles and preferences, though the results need confirmation through prospective randomized trials.
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⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
Background: In obstructive hypertrophic cardiomyopathy, surgical myectomy is highly effective but carries a recognized risk of postoperative conduction disturbances. Percutaneous intramyocardial septal radiofrequency ablation (Liwen procedure) is a less invasive alternative, but head-to-head comparisons of longitudinal hemodynamic trajectories and conduction system safety remain scarce, limiting evidence-based treatment selection. Methods: This single-center retrospective cohort included 211 patients treated 2018?2023 (124 Liwen, 87 modified Morrow myectomy). The primary longitudinal analysis included 133 patients with 1-year follow-up and serial data (75 Liwen, 58 modified Morrow myectomy). Repeated outcomes were analyzed using linear mixed-effects models and generalized estimating equations, adjusted for baseline covariates. Results: Both procedures reduced LVOT gradient, but trajectories differed (interaction P=0.002). At 1 year, the covariate-adjusted mean LVOT gradient remained higher after Liwen than after myectomy (16.1 vs 1.3 mmHg, P<0.001). However, the adjusted 1-year predicted probability of new conduction abnormalities was markedly lower after Liwen (5% vs 62%, P<0.001), with no permanent pacemaker implantations in the Liwen group. Most patients achieved gradient <30 mmHg in both groups (82% vs 96%; nominal P=0.308). Liwen had shorter procedure duration (80 vs 185 min) and hospital stay (11 vs 16 days). Serious adverse event rates were similar (8.1% vs 9.2%) but profiles differed. Conclusions: Modified Morrow myectomy achieved more complete LVOT gradient reduction at 1 year, whereas Liwen ablation had fewer conduction abnormalities, shorter procedure duration, and shorter hospital stay. These findings highlight a clinically relevant trade-off between more complete hemodynamic relief and lower conduction-system injury and require prospective confirmation.