Early Inpatient Implementation of an ERAS-Informed Stepwise Rehabilitation Pathway After Percutaneous Intramyocardial Septal Radiofrequency Ablation for Obstructive Hypertrophic Cardiomyopathy: A Retrospective Cohort Study

Background: Percutaneous intramyocardial septal radiofrequency ablation (PIMSRA), also known as the Liwen procedure, is an emerging septal reduction therapy for obstructive hypertrophic cardiomyopathy (OHCM), but standardized early rehabilitation pathways after PIMSRA are lacking. We aimed to develop an enhanced recovery after surgery (ERAS)-informed, risk-stratified stepwise rehabilitation pathway after PIMSRA, describe its documented early inpatient implementation in selected clinically stable patients, report preliminary in-hospital safety observations, and explore its associations with hospitalization outcomes. Methods: This exploratory single-center retrospective cohort study included 102 patients with OHCM who underwent first-time PIMSRA between 1 July 2023 and 3 August 2025 and met the same predefined post-PIMSRA rehabilitation eligibility criteria. Patients were classified according to the care pathway actually received: usual care (n = 53) or early inpatient implementation of the ERAS-informed rehabilitation pathway plus usual care (n = 49). The planned pathway incorporated rehabilitation eligibility screening, risk stratification, staged early mobilization, structured physiological monitoring with predefined stop criteria, multidisciplinary coordination, and patient education. Pathway selection was nonrandomized and reflected patient- or family-related preferences and implementation or logistical factors. Results: The ERAS-informed group had a shorter ICU length of stay than the usual-care group in the primary analysis [20.0 (5.8–26.6) h vs. 23.0 (17.1–45.5) h; Hodges–Lehmann difference, −6.0 h; 95% CI, −16.51 to −0.53; p = 0.022]. Three ICU stays > 100 h occurred in the usual-care group and none in the ERAS-informed group; after excluding these observations, the comparison was attenuated (p = 0.060). The total hospital length of stay was shorter in the ERAS-informed group [8.0 (7.0–11.0) d vs. 9.0 (8.0–13.0) d; difference, −1.0 d; 95% CI, −2.02 to −0.03; p = 0.029], whereas the post-PIMSRA length of stay did not differ significantly (p = 0.058). The admission-to-PIMSRA interval was also not significantly different (p = 0.309). No rehabilitation-related adverse events were recorded in the ERAS-informed group during hospitalization (0/49; exact binomial 95% CI, 0.0–7.3%). Conclusions: Among selected clinically stable patients after PIMSRA, early inpatient implementation of pathway components was achievable, primarily during the period corresponding to planned stages 1–2. No rehabilitation-related adverse events were recorded, providing preliminary patient-level in-hospital safety observations. Fidelity, adherence, completion, and reproducibility of the complete four-stage, risk-stratified pathway were not established. Length-of-stay associations were exploratory and should not be interpreted causally.