Hypertrophic cardiomyopathy (HCM) is a common genetic cardiovascular disorder with an estimated prevalence of 0.1-0.5% in the general population. LV outflow obstruction is a strong determinant of HCM-related progressive heart failure and cardiovascular death. We developed a concept for a non-surgical, minimally invasive device therapy for patients with hypertrophic obstructive cardiomyopathy based on the biophysical phenomenon of electroporation. Irreversible electroporation (IRE) is a biophysical phenomenon whereby microseconds direct current electric pulses are applied across the cell membrane and increase its permeability. It is an emergency non thermal cell ablation approach that is already in clinical use for the treatment of solid tumors. In our studies with small animal models we have demonstrated the feasibility of this modality to ablate blood vessel wall, left ventricular myocardial tissue, and to induce tissue decellularization (Figure 1). We hypothesize that IRE can be used in an endovascular, transcatheter approach to induce efficient ablation of obstructive ventricular septum in patients with HCM. This approach will be ideal for high risk patients and for patients with limited access to highly skilled cardiothoracic centers. In addition, we believe that IRE ablation offers specific advantages over alcohol septal ablation (high efficiency, accurate anatomic ablation, short procedural duration time). Our suggested Prototype (Figure 2) can be used to induce strong uniform electric field in the ventricular septum in an endovascular minimally invasive approach.
