Early Experience With Septal Scoring Along the Midline Endocardium in the Asia-Pacific Region

Septal Scoring Along the Midline Endocardium (SESAME) is a novel transcatheter electrosurgical technique for septal reduction that has been reported in the United States and Europe, but experience in the Asia-Pacific region has not been previously described. We report four cases of SESAME procedures performed in the Asia-Pacific region, encompassing diverse clinical scenarios including standalone treatment for hypertrophic obstructive cardiomyopathy (HOCM) in patients with persistent symptoms despite prior alcohol septal ablation or lack of suitable septal branches, and as an adjunct to transcatheter aortic valve replacement (TAVR) in patients with concomitant severe aortic stenosis and septal hypertrophy. The procedures were successfully completed in all cases with reduction in left ventricular outflow tract (LVOT) gradients. One patient developed high-grade atrioventricular block requiring permanent pacemaker implantation. At follow-up ranging from 1 to 3 months, patients demonstrated improved LVOT gradients and functional status. This case series demonstrates the feasibility of SESAME in the Asia-Pacific region for various indications including standalone HOCM treatment and prevention of LVOT obstruction in conjunction with TAVR. Further multicenter studies are needed to evaluate the long-term outcomes and safety profile of this emerging technique in diverse patient populations.