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Case Report Open Access

Endocardial radiofrequency ablation for the treatment of pediatric hypertrophic cardiomyopathy: A report of two cases and a brief review of the literature

  • Authors:
    • Fan Zhang
    • Bo Wang
    • Ye Chen
    • Wenjuan Shu
    • Jie Huang
    • Ling Sun
  • View Affiliations / Copyright

    Affiliations: Department of Cardiology, Children's Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
    Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 45
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    Published online on: June 23, 2026
       https://doi.org/10.3892/mi.2026.329
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Abstract

The present case report evaluated the application and outcomes of endocardial radiofrequency ablation (ERFA) in children with hypertrophic cardiomyopathy (HCM). The clinical data, procedural details and short‑term follow‑up of two pediatric patients with HCM admitted to the department of cardiology from 2023 to 2024. In addition, literature published between 2012 and 2025 was reviewed using the key words ‘endocardial radiofrequency ablation’, ‘children’ and ‘hypertrophic cardiomyopathy’ to summarize the current status and efficacy of ERFA in pediatric HCM. The first reported case was that of a 9‑year‑old boy who presented with reduced exercise tolerance for 6 months. An echocardiography revealed asymmetric hypertrophy of the interventricular septum and left ventricular wall, positive systolic anterior motion (SAM) sign and left ventricular outflow tract (LVOT) obstruction. Genetic testing indicated variants in LZTR1, suggestive of Noonan syndrome type 10. Despite medication (metoprolol and captopril), LVOT obstruction progressed (gradient >50 mmHg). ERFA was performed, and follow‑up at 2 months showed reduced septal thickness and alleviated LVOT obstruction. The second case was that of an 11‑year‑ and ‑11‑month‑old girl who presented with 3 years of dizziness and fatigue. An echocardiography confirmed asymmetric left ventricular hypertrophy, LVOT obstruction and SAM sign. Post‑ERFA, LVOT obstruction significantly improved. Literature reports on ERFA for pediatric HCM are limited. Combined with adult series, ERFA appears safer than surgical myectomy or alcohol septal ablation, although long‑term efficacy requires further validation. On the whole, the present case report demonstrates that ERFA is a safe and effective intervention for pediatric HCM when pharmacological therapy fails, providing a viable minimally alternative.
View Figures

Figure 1

Echocardiographic and
electrocardiographic findings for case 1. (A and B) Pre-operative
echocardiographic images demonstrating asymmetric hypertrophy of
the interventricular septum and left ventricular wall, with
positive SAM of the mitral valve. The LVOT measured ~6.3 mm at its
narrowest point, with a peak velocity of ~4 m/sec, corresponding to
a gradient of 65 mmHg. (C and D) Post-operative (2-month follow-up)
echocardiographic views demonstrating the resolution of the SAM
phenomenon. The minimal LVOT diameter increased to 11.9 mm, with a
reduced peak velocity of ~2.1 m/sec, corresponding to a
significantly lower gradient of 18 mmHg. (E) Pre-operative and (F)
2-month post-operative electrocardiogram tracings. LVOT, left
ventricular outflow tract; SAM, systolic anterior motion.

Figure 2

Genetic testing results for case 1.
(A) An adenine was substituted by cytosine at the second base of
the 3' end of position 1261 in intron 11 of the LZTR1 gene.
This variant was classified as ‘likely pathogenic’ according to the
ACMG guidelines (29). (B) A
guanine-to-adenine substitution at position 1648 in exon 15 of the
LZTR1 gene resulted in a missense mutation. It was rated as
a ‘variant of uncertain significance’ based on the ACMG guidelines.
Genetic variants were verified by Sanger sequencing. Target
fragments were amplified by PCR and cloned into pMD19-T plasmid.
Sequencing was carried out with BigDye Terminator v3.1 kit on an
ABI 3730xl DNA Analyzer according to the manufacturer's
protocols.

Figure 3

Cardiac MRI reports of the two
pediatric patients. (A and B) MRI images of case 1 and case 2,
respectively. The images reveal significant myocardial hypertrophy
in both pediatric cases.

Figure 4

Echocardiographic and
electrocardiographic findings for case 2. (A and B) Pre-operative
echocardiograms demonstrate asymmetric left ventricular hypertrophy
and systolic anterior motion of the mitral valve. The LVOT measured
~6.8 mm at its narrowest point, with a peak velocity of 5.7 m/sec,
corresponding to a gradient of 131 mmHg. (C and D) Post-operative
(2-month follow-up) echocardiograms demonstrating that the minimal
LVOT diameter increased to 12.5 mm. The peak velocity was reduced
to 4.2 m/s, corresponding to a gradient of 72 mmHg. (E)
Pre-operative and (F) 2-month post-operative electrocardiogram
tracings. LVOT, left ventricular outflow tract.
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Spandidos Publications style
Zhang F, Wang B, Chen Y, Shu W, Huang J and Sun L: Endocardial radiofrequency ablation for the treatment of pediatric hypertrophic cardiomyopathy: A report of two cases and a brief review of the literature. Med Int 6: 45, 2026.
APA
Zhang, F., Wang, B., Chen, Y., Shu, W., Huang, J., & Sun, L. (2026). Endocardial radiofrequency ablation for the treatment of pediatric hypertrophic cardiomyopathy: A report of two cases and a brief review of the literature. Medicine International, 6, 45. https://doi.org/10.3892/mi.2026.329
MLA
Zhang, F., Wang, B., Chen, Y., Shu, W., Huang, J., Sun, L."Endocardial radiofrequency ablation for the treatment of pediatric hypertrophic cardiomyopathy: A report of two cases and a brief review of the literature". Medicine International 6.4 (2026): 45.
Chicago
Zhang, F., Wang, B., Chen, Y., Shu, W., Huang, J., Sun, L."Endocardial radiofrequency ablation for the treatment of pediatric hypertrophic cardiomyopathy: A report of two cases and a brief review of the literature". Medicine International 6, no. 4 (2026): 45. https://doi.org/10.3892/mi.2026.329
Copy and paste a formatted citation
x
Spandidos Publications style
Zhang F, Wang B, Chen Y, Shu W, Huang J and Sun L: Endocardial radiofrequency ablation for the treatment of pediatric hypertrophic cardiomyopathy: A report of two cases and a brief review of the literature. Med Int 6: 45, 2026.
APA
Zhang, F., Wang, B., Chen, Y., Shu, W., Huang, J., & Sun, L. (2026). Endocardial radiofrequency ablation for the treatment of pediatric hypertrophic cardiomyopathy: A report of two cases and a brief review of the literature. Medicine International, 6, 45. https://doi.org/10.3892/mi.2026.329
MLA
Zhang, F., Wang, B., Chen, Y., Shu, W., Huang, J., Sun, L."Endocardial radiofrequency ablation for the treatment of pediatric hypertrophic cardiomyopathy: A report of two cases and a brief review of the literature". Medicine International 6.4 (2026): 45.
Chicago
Zhang, F., Wang, B., Chen, Y., Shu, W., Huang, J., Sun, L."Endocardial radiofrequency ablation for the treatment of pediatric hypertrophic cardiomyopathy: A report of two cases and a brief review of the literature". Medicine International 6, no. 4 (2026): 45. https://doi.org/10.3892/mi.2026.329
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