Alcohol Septal Ablation
Alcohol septal ablation (ASA) is a minimally-invasive treatment for hypertrophic cardiomyopathy. Hypertrophic cardiomyopathy is the thickening of the septum that separates the bottom chambers of the heart. The thickening restricts the blood flow out of the left side of the heart and can cause syncope (passing out), heart arrhythmias and sometimes sudden death. Alcohol septal ablation is performed to decrease the thickening of the septum by injecting a small amount of alcohol into the vessel to cause a mild heart attack. This causes the septum to shrink in size, thus relieving symptoms.
Who is a for Alcohol Septal Ablation Candidate?
Patients who have hypertrophic cardiomyopathy and who are symptomatic; dizzy, lightheaded, have had syncope or shortness of breath may be candidates for alcohol septal ablation. ASA is an alternative treatment option to surgical myectomy or removal of a portion of the septum. It may be the better choice in elderly patients and those with advanced medical conditions that won’t tolerate the myectomy or open heart surgery well.
The patient is brought to the catheterization lab and is given a mild sedative to relax during the procedure. The groin area is shaved and cleansed with an anti-septic so the interventional cardiologist can make an incision into the artery where the catheter needs to go. The skin is numbed with anesthetic and a sheath (like an IV) is placed in the artery. Through the sheath a catheter is passed to the appropriate vessel of the heart and then a balloon is inflated inside the vessel to temporarily block blood flow. A small amount of alcohol (2-5 cc) is injected into the vessel to cause the muscle cells to shrink and die. A temporary pacemaker wire is left in the heart for approximately 24 hours while the heart recovers from the injection. The other catheters are removed, the groin is stitched closed. The patient is taken to the Heart & Vascular Institute where they stay for 24-48 hours to recover.
Risks of Alcohol Septal Ablation
- Heart attack or damage to other parts of the heart
- Severe lung damage
- Heart rhythm problems that may require a permanent pacemaker
- Kidney failure
- Vascular damage to the femoral artery
Alcohol Septal Ablation Recovery
The temporary pacemaker wire is left in for approximately 24 hours and is used in case there are heart rhythm problems. If there is evidence of heart block or other more permanent rhythm disturbances, a permanent pacemaker may need to be implanted. The patient is able to walk in the halls and once the patient is stable they are discharged home. Follow up with the interventional cardiologist will take place approximately 3 days after discharge. The patient should notice that they aren’t as short of breath with exertion, don’t experience as much dizziness or lightheadedness as time goes on and the septum continues to shrink. It is important to continue taking the medications that are prescribed by the cardiologist, even after this procedure.