Percutaneous Intramyocardial Septal Radiofrequency Ablation (Liwen Procedure) for Hypertrophic Cardiomyopathy: A Decade of Evolution, Clinical Experience and Future Perspectives

Abstract Hypertrophic cardiomyopathy (HCM) is an inherited cardiomyopathy. For patients with obstructive hypertrophic cardiomyopathy (oHCM) who remain symptomatic despite medical therapy, septal reduction therapy can be performed. Surgical septal myectomy and alcohol septal ablation are the treatments for relieving left ventricular outflow tract obstruction and can effectively improve patients’ quality of life. In recent years, percutaneous intramyocardial septal radiofrequency ablation (PIMSRA/Liwen procedure) has emerged as a novel treatment for oHCM. This review traces its ten-year development from animal experiments to clinical application, covering technical principles, safety, and efficacy. Additional potentially extended applications are being explored, including non-obstructive HCM and other coexisting cardiac conditions. Future directions include longer-term follow-up, and multicenter collaboration to validate efficacy and safety in HCM patients. This review summarizes the current knowledge on PIMSRA/Liwen procedure and raises several issues that deserve further investigation.