Alcohol septal ablation is a non-surgical procedure to treat hypertrophic cardiomyopathy. This is an inherited condition in which your heart muscle is abnormally thick. This procedure decreases your symptoms and to reduces future complications.
Your left and right ventricles are the 2 lower chambers of your heart. A muscular wall called the septum separates these 2 ventricles. In hypertrophic cardiomyopathy, the walls of your ventricles and septum may thicken abnormally. The septum may bulge into your left ventricle and partially block the blood flow out to your body. This places extra pressure on your heart. It also contributes to many symptoms of the disease. These may include fatigue and shortness of breath.
Alcohol septal ablation requires a thin, flexible tube called a catheter. It has a balloon at the tip. Your doctor threads the tube through a blood vessel in your groin all the way to the artery that carries blood to your septum. Your doctor then injects alcohol, through the tube, into the area where the heart is too thick. The alcohol is toxic and causes some of your heart muscle cells to shrink and die. Remaining scar tissue is thinner than the heart muscle. This improves blood flow through your heart and out to your body. Your healthcare provider then deflates the balloon and guides the tube back out of your body.
For many people with hypertrophic cardiomyopathy, medicines are enough to treat their condition. However, some people with significant symptoms don’t respond well to medicine. These people may benefit from alcohol septal ablation. This procedure is usually very effective at reducing symptoms in these people. Some women might need alcohol septal ablation before becoming pregnant, even if their symptoms aren’t severe.
Septal myectomy is another option for many people considering alcohol septal ablation. Both procedures decrease the thickness of the septum. In septal myectomy, a surgeon removes excess muscle from the thickened septum. Because septal myectomy is a type of open-heart surgery, it takes longer to recover. However, alcohol septal ablation may pose a slightly increased risk for certain complications, such as the need for a pacemaker.
Some people can have either septal myectomy or alcohol septal ablation. Others might do better with one or the other. Talk to your doctor about the risks and benefits to each technique. Alcohol septal ablation is often preferred in older people and in those whose thickening is less severe. Some medical conditions may increase the risk of open-heart surgery. In that case, alcohol septal ablation may be a better option for you. If you have other heart abnormalities that require repair, you may need septal myectomy instead.
Most people who have alcohol septal ablation have a successful outcome. There are possible risks, though. Your risks will partly depend on your medical history. Talk with your doctor about any concerns you have.
The risks include:
- Abnormal heart rhythms (fast or slow)
- Heart block
- Bleeding at the site where your healthcare provider inserts the catheter
- Blood clots
- Tears in your heart tissue
- Abnormal fluid buildup around your heart
- Coronary artery complications
- Failure of the procedure to work effectively
Heart block is one of the most common complications. Heart block is a disruption to the electrical signals through your heart that can result in slow heart rate. Certain kinds of heart block require treatment with a permanent pacemaker. If tears occur to the heart tissue, you may require open-heart surgery.
You are at greater risk for complications if you are older or if you have other heart problems. Hospitals and doctors who specialize in alcohol septal ablations have the lowest rates of complications.
Talk with your healthcare provider about how to prepare for your alcohol septal ablation. Work with him or her to find an experienced medical center and doctor to do the procedure. Make sure your healthcare providers know all the medicines you take. You may need to stop taking certain medicines before the procedure, such as beta-blockers. Do not drink or eat anything after midnight the day before your procedure.
You may have the following tests before your alcohol septal ablation:
- Chest X-ray
- Blood tests
- Electrocardiogram (ECG)
These tests will help your healthcare provider know what your heart looks like. Testing also may detect other potential conditions that can affect the procedure.
Talk with your healthcare provider about what to expect during your procedure. It may take 1 to 2 hours or more, depending on your case. It is usually done in a cardiac catheterization lab. A heart doctor and a special team of nurses and technicians will do the ablation. During the procedure:
- You will be awake.
- The team may give you medicine that helps you relax.
- The team may give you aspirin and heparin (a common blood thinner) before the procedure. This will help to reduce the likelihood of blood clots.
- The groin area where the catheter will be inserted may need to be shaved. A local anesthetic (numbing medicine) is applied to your skin, and the small incision is made.
- Your doctor will insert a small, flexible tube (catheter) into an artery or vein in your groin.
- The doctor will thread the tube through your blood vessels all the way to your heart.
- Your doctor may use angiography, along with a special type of echocardiogram to make sure the catheter is in the right place.
- A small amount of pure alcohol is released into an artery in your septum. This destroys part of the septum muscle. This may feel uncomfortable.
- Your healthcare provider will take measurements of the pressure in your heart to ensure it has improved.
- The team will remove the tubes through your groin.
- The team will close and bandage the site where they inserted the tubes.
Talk with your healthcare provider about what you need to do after the alcohol septal ablation.
In the hospital after the procedure:
- You will spend several hours in a recovery room.
- The team will monitor your vital signs, such as your heart rate and breathing.
- The team may do an echocardiogram after the procedure to view your septum and left ventricle. This will show your healthcare provider how successful the ablation was.
- You will need to lie flat for several hours after the procedure. You should not bend your legs. This will help prevent bleeding.
- Your healthcare provider might prescribe medicines that keep your blood from clotting (anticoagulants).
- You may also get pain medicine if you need it.
- You will probably stay in the cardiac intensive care unit for observation for 1 to 3 days.
- If you have a heart rhythm problem called heart block, you may need to have a permanent pacemaker placed.
- You can expect to spend about 3 days or more, but time in the hospital can vary.
At home after the procedure:
- You should talk with your healthcare provider about continuing your normal medicines.
- You should also discuss when it is appropriate to start exercising again.
- You will probably be able to return to light activity relatively soon.
Most people who have an alcohol septal ablation note immediate improvement of their symptoms. Your symptoms may continue for a while after the procedure.
After you leave the hospital, it is important to follow all the instructions your healthcare provider gives you for medicines, exercise, diet, and wound care. Be sure to keep all your follow-up appointments.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
January 11, 2018
Hypertrophic cardiomyopathy: Nonparmacologic treatment of left ventricular outflow tract obstruction, Up To Date
Kang, Steven, MD,Fetterman, Anne, RN, BSN