Alcohol Septal Ablation

Alcohol septal ablation is a procedure performed to treat one form of hypertrophic cardiomyopathy (HCM), a condition characterized by the thickening of the heart muscle obstructing blood from the heart to the rest of the body. The minimally invasive procedure involves injecting alcohol into a specific artery using a catheter (a long, thin tube) to induce controlled damage and reduce the thickened portion of the heart muscle, thus improving blood flow to the body and reducing symptoms.

 

Treatments

The primary treatment options for hypertrophic cardiomyopathy include medication management, lifestyle modifications, and invasive procedures such as alcohol septal ablation, coil embolization, or surgical myectomy.

 

Why it’s needed

Alcohol septal ablation is needed to:

  • Relieve symptoms associated with obstructive hypertrophic cardiomyopathy, such as shortness of breath, chest pain, fatigue, and lightheadedness. This heart condition is typically hereditary (passed down through families).
  • Improve blood flow through the heart by reducing the obstruction caused by the thickened heart muscle.
  • Enhance the heart’s pumping function and reduce the risk of complications.

 

Before the procedure

Preparing for alcohol septal ablation may include:

  • Comprehensive medical evaluation, including imaging tests and blood work.
  • Discussion with your healthcare team about the procedure, potential risks, and benefits.
  • Fasting for a specific period before the procedure.
  • Temporary discontinuation or adjustment of certain medications, as advised by your physician.
  • Arranging transportation to and from the hospital.

 

During the procedure

During alcohol septal ablation:

  • Local anesthesia or sedation will be administered to ensure you are comfortable during the procedure.
  • A thin tube called a catheter is inserted through a blood vessel in the groin and guided to the heart.
  • Contrast dye may be injected to visualize the heart and its structures.
  • Once the target artery is identified, a small amount of alcohol is injected through the catheter, causing controlled damage to the thickened heart muscle.
  • The alcohol induces a localized reduction in the thickened area, improving blood flow and reducing the obstruction.
  • The catheter is then removed, and pressure is applied to the insertion site to prevent bleeding.
  • The insertion site is cleaned and dressed with a sterile bandage.

 

After the procedure

After alcohol septal ablation:

  • You will be monitored in a recovery area for a few hours.
  • The healthcare team will assess your vital signs and monitor for any complications or adverse reactions.
  • Pain management and medication to prevent blood clots may be provided.
  • You may be required to stay overnight in the hospital for further observation.

 

Risks

Alcohol septal ablation carries risks and potential complications, including:

  • Arrhythmias (irregular heart rhythms).
  • Bleeding or hematoma at the catheter insertion site.
  • Damage to the coronary arteries or heart valves.
  • Heart block (a disruption in the electrical signals that regulate the heartbeat) that may need a permanent pacemaker placement.
  • Perforation of the heart wall.
  • Allergic reactions to anesthesia or medications.
  • Stroke (rare).

 

Typical recovery time

Recovery time after alcohol septal ablation varies, but most individuals can expect to stay in the hospital for one to two days. The overall recovery period may take several weeks, during which time you may experience fatigue and limited physical activity. Full recovery can take a few months.

 

Results and post-procedure care

Symptoms should improve within 6 months of the alcohol septal ablation. Please note:

  • Follow your healthcare team’s instructions regarding medications, wound care, and physical activity.
  • Attend all recommended follow-up appointments for monitoring and evaluation.
  • Report any concerning symptoms or complications promptly, such as chest pain, shortness of breath, or irregular heart rhythms.
  • Long-term management may include medication management, regular check-ups, and lifestyle modifications to manage hypertrophic cardiomyopathy.