BMC Cardiovascular Disorders· 2026Q2· Case report
Case report: septal radiofrequency ablation for sigmoid ventricular septum-related dynamic obstruction: with observations suggesting left bundle branch block as a potential therapeutic collaborator
- 0citations
- Q2SCImago
- 2026year
Short summary
Radiofrequency ablation (RFA) of the basal septum in a 77-year-old woman with sigmoid ventricular septum (SVS)-related dynamic obstruction resolved severe outflow tract obstruction (210 mmHg gradient) and mitral valve systolic anterior motion (SAM), resulting in a new complete left bundle branch block (CLBBB) and a 14 mmHg gradient post-procedure.
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Key points
- Radiofrequency ablation (RFA) of the basal septum was performed on a patient with symptomatic dynamic LVOTO secondary to SVS.
- Pre-ablation dobutamine stress echocardiography showed a peak gradient of 210 mmHg with systolic anterior motion (SAM) and a systolic vortex.
- Post-ablation, the patient developed complete left bundle branch block (CLBBB) and repeat stress echocardiography showed a resolved gradient of 14 mmHg, absent SAM, and restored laminar flow.
- Strain analysis indicated reduced, delayed, and post-systolic contraction of the basal septum after ablation.
AI-generated from the title and abstract; the full text is not read.
Abstract
Abstract Background Sigmoid ventricular septum (SVS) can cause dynamic left ventricular outflow tract obstruction (LVOTO) during stress. Radiofrequency ablation (RFA) has been used for septal reduction in hypertrophic obstructive cardiomyopathy, but its application in SVS is limited and the underlying mechanisms remain poorly understood. Results A 77-year-old woman with symptomatic dynamic LVOTO secondary to SVS underwent endocardial RFA after failing medical therapy. Dobutamine stress echocardiography (DSE) before ablation provoked severe obstruction (peak gradient 210 mmHg) with systolic anterior motion (SAM) of the mitral valve and a large systolic vortex on blood speckle imaging (BSI). After targeted RFA of the basal septum, the patient developed new-onset complete left bundle branch block (CLBBB). Repeat DSE demonstrated resolution of SAM and obstruction (peak gradient 14 mmHg), with BSI showing restoration of laminar flow. Strain analysis revealed reduced, delayed, and post-systolic contraction of the basal septum. At 3-month follow-up, the patient remained asymptomatic. Conclusions This case raises the hypothesis that CLBBB may have contributed synergistically to obstruction relief in RFA treatment for SVS-related dynamic LVOTO.
The authors' abstract, as published at the source. BMC Cardiovascular Disorders, 2026 · DOI ↗
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Field: Cardiology and Cardiovascular Medicine
Cardiology and Cardiovascular MedicineMedicine