Loading ...

The Hospital de Santa Marta, Lisbon, Portugal, part of Portugal’s National Health Service, has introduced radiofrequency septal ablation, a procedure developed within Brazil’s public health system at the Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.

The technique has been shown to reduce risks and shorten hospital stays for patients with hypertrophic cardiomyopathy (HCM).

Brazilian cardiologists A. Tito Paladino Filho, MD, PhD, and Bruno Pereira Valdigem, MD, PhD, are physicians at the Dante Pazzanese.

Valdigem, who also serves on Medscape’s editorial board, visited Lisbon in late July. Their trip was organized by Bruno Tereno Valente, MD, cardiac electrophysiologist in the Arrhythmology, Pacing, and Electrophysiology Unit at the Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central.

The program included lectures, technical demonstrations, and direct supervision of the first radiofrequency septal ablation procedure performed in Portugal.

Disease Challenge

HCM, a genetic condition that affects approximately 0.2% of the global population, causes thickening of the heart muscle, most often in the left ventricle, which can obstruct blood flow into the aorta.

Invasive treatment is required when pharmacological treatment is insufficient. Since the 1960s, surgical myectomy has been the standard treatment.

Although myectomy offers favorable outcomes, it carries higher risks in patients with comorbidities and when performed in centers with limited surgical expertise.

First performed in 1994, alcohol septal ablation (ASA) has emerged as a less invasive option for patients who are unsuitable for surgery.

ASA uses catheter-based ethanol infusion to induce controlled myocardial infarction. Although ASA is associated with lower morbidity and reduced resource demands than myectomy, it is limited by the coronary artery anatomy and the unpredictable extent of myocardial damage. Up to 20% of patients are ineligible for surgery.

Valdigem explained that his team, building on the work led by Thorsten Lawrenz, MD, in Germany, used radiofrequency ablation catheters, traditionally used for arrhythmias such as atrial fibrillation or ventricular tachycardia, to replicate the effects of alcohol with greater precision.

Speaking with Medscape’s Portuguese edition, Valdigem confirmed, “Instead of inducing chemical infarction with alcohol, we cauterized only the necessary muscle area using catheters. This produces results comparable to surgery but in a less invasive and more cost-effective way, which is critical in Brazil’s Unified Health System (SUS).”

Procedural Innovation

Radiofrequency septal ablation performed under general anesthesia in a catheterization laboratory is guided by transesophageal echocardiography (TEE). 

Energy between 50 W and 70 W is delivered to create a localized scar that prevents the septum from obstructing the left ventricular outflow tract. The procedure lasts about 3 hours. Patients usually spend 1-2 days in the ICU, followed by 2-3 days in the recovery room.

Paladino Filho highlighted the novelty of echocardiographic guidance. 

“TEE is rarely used in similar procedures and is applied exclusively in this technique, which was adapted by Valdigem. Initially, I was skeptical, but the patients progressed well, and echocardiography clearly enhanced precision,” he stated.

Valdigem added that this approach avoids thoracotomy and cardiopulmonary bypass, both of which are required in myectomy, and bypasses the coronary anatomical limitations that restrict ASA use.

At the Dante Pazzanese, more than 110 patients underwent radiofrequency septal ablation. Two deaths were reported in patients with advanced diseases. 

Most patients achieved favorable results. Published results have confirmed that the safety and efficacy of this technique are comparable to those of myectomy, supporting its growing global recognition.

Scientific Exchange

The Hospital de Santa Marta, a national reference center for obstructive HCM, previously offered ASA only. “We wanted to expand our therapeutic portfolio by adding this Brazilian technique, so we could select the best approach for each patient,” Valente noted.

In early 2025, Valente travelled to São Paulo to observe the procedures at the Dante Pazzanese. “This exchange of knowledge was interesting for both parties. I believe that having a common language is also helpful. The simple fact of being able to communicate with the entire team in your native language during a procedure is incredibly valuable,” he said.

During this visit, he was accompanied by cardiologist António Fiarresga, MD, from the Hospital CUF Tejo in Lisbon. 

Valente delivered lectures to the residents of the Dante Pazzanese. The sessions included discussions on the removal of old pacemaker leads and the ASA protocols used in Portugal.

This collaboration led to Valdigem and Paladino Filho’s visit to Lisbon, where they trained the staff and jointly performed radiofrequency septal ablation in three Portuguese patients.

“International integration in medicine is routine, especially at conferences and online sessions. However, procedural work is different. Developing a technique in Brazil and teaching it abroad is less common,” said Paladino Filho, who noted the pioneering nature of this project.

“The fact that a public SUS hospital in Brazil created and shared a technique internationally shows that, despite challenges, our country has great medical potential.”

Valdigem concurred, “This project brought together physicians from many specialties at the Dante Pazzanese. This was a wonderful team effort, and we are pleased with the outcome. As the son of Portuguese parents, I also felt personally proud.”

This story was translated from Medscape’s Portuguese edition.