What is alcohol septal ablation?

Alcohol septal ablation is a nonsurgical procedure to treat hypertrophic cardiomyopathy. This is an inherited condition in which your heart muscle is abnormally thick. This procedure decreases your symptoms. It also 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 uses a thin, flexible tube called a catheter. It has a balloon at the tip. Your healthcare provider threads the tube through a blood vessel in your groin. It goes all the way to the artery that carries blood to your septum. Your healthcare provider 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. The remaining scar tissue is thinner than the thickened heart muscle was before. Blood is able to get past the thinned muscle and through the aortic heart valve. 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.

Why might I need alcohol septal ablation?

For many people with hypertrophic cardiomyopathy, medicines are enough to treat their condition. But some people with severe symptoms don’t respond well to medicine. These people may get help from alcohol septal ablation. This procedure usually works very well to reduce symptoms. If you plan to get pregnant, you may need alcohol septal ablation before getting pregnant, even if your symptoms aren’t severe. This procedure may prevent the need for cardiac surgery.

Septal myectomy is another option for those considering alcohol septal ablation. Both procedures decrease the thickness of the septum. In septal myectomy, a surgeon removes extra muscle from the thickened septum. Because septal myectomy is a type of open heart surgery, it takes longer to recover. But alcohol septal ablation and septal myectomy may increase 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 with your healthcare provider about the risks and benefits of each technique. Alcohol septal ablation is often preferred in older people and those whose thickening is not too 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 to repair, you may need septal myectomy instead.

What are the risks of alcohol septal ablation?

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 healthcare provider about any concerns you have.

The risks include:

• Abnormal heart rhythms (fast or slow)

• Heart block that requires a pacemaker

• Bleeding at the site where your healthcare provider inserts the catheter

• Infection

• Blood clots

• Abnormal fluid buildup around your heart

• Coronary artery complications

• Shock

• 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 a slow heart rate. Certain kinds of heart block require treatment with a permanent pacemaker. If bleeding around the heart occurs, you may need open heart surgery.

You are at greater risk for complications if you are older or if you have other heart problems. Hospitals and healthcare providers who specialize in alcohol septal ablations have the lowest rates of complications.

How do I get ready for alcohol septal ablation?

Talk with your healthcare provider about how to prepare for your alcohol septal ablation. Work with them to find an experienced medical center and provider to do the procedure. Follow any directions you are given for not eating or drinking before surgery.

You may have these tests before your alcohol septal ablation:

• Chest X-ray

• Blood tests

• Echocardiogram

• Electrocardiogram (ECG)

• Cardiac MRI

These tests will help your healthcare provider know what your heart looks like. Testing may find other potential conditions that can affect the procedure.

Tell your healthcare team about your health history. Also tell them about all medicines you take, including over-the-counter medicines, herbal medicines, and supplements. You may need to stop taking certain medicines before the procedure, such as beta-blockers. Tell your provider if you think you are pregnant or if you are breastfeeding. Tell your healthcare team about any allergies you have. These include allergies to contrast dye, skin preparations, and anesthesia or sedatives.

What happens during alcohol septal ablation?

Talk with your healthcare provider about what to expect during your procedure. It may take 1 to 2 hours or more. That will depend on your case. It's usually done in a cardiac catheterization lab. A heart specialist and a special team of nurses and technicians will do the ablation. During the procedure:

• 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 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. A small incision is made.

• Your healthcare provider will insert a small, flexible tube (catheter) into an artery or vein in your groin.

• The healthcare provider will thread the tube through your blood vessels all the way to your heart.

• Your healthcare provider 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 from your groin.

• The team will close and bandage the site where they inserted the tubes.

What happens after alcohol septal ablation?

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. They'll check 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. Do 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.

• 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 2 to 3 days or more in the hospital. The time can vary.

At home after the procedure:

• Talk with your healthcare provider about continuing your normal medicines.

• Discuss when it's OK to start exercising again.

• You will probably be able to return to light activity relatively soon.

Most people who have an alcohol septal ablation see their symptoms improve quickly. Your symptoms may continue for a while after the procedure.

After you leave the hospital, it's important to follow all the instructions your healthcare provider gives you for medicines, exercise, diet, and wound care. Keep all your follow-up appointments.

Next steps

Before you agree to the test or the procedure, find out:

• 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

• The possible side effects or complications

• 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 you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure