A Cutting-Edge, Non-Surgical Treatment for HCM
Alcohol septal ablation is a non-surgical procedure that can safely and effectively relieve an obstruction caused by hypertrophic cardiomyopathy (HCM). This inherited condition makes your heart muscle abnormally thick, which can lead to lifelong complications. Alcohol septal ablation can decrease your symptoms and reduce future complications.
People with HCM often have the following symptoms:
- Fatigue
- Shortness of breath
- Extra heartbeats
- Chest discomfort
- Feeling faint or passing out
What Happens During Alcohol Septal Ablation?
During this procedure, a thin, flexible tube (catheter) with a balloon at the tip is threaded through the arteries in your leg to find the small artery that supplies blood to that abnormal muscle (septum). We use X-rays and echocardiography to help us find the artery. Some people may not have an artery that can be used to deliver alcohol, and when this occurs we stop the procedure and consider surgical options (like septal myectomy).
When the correct artery is identified, a very small amount of alcohol is injected through the balloon to kill (ablate) the abnormal muscle. The alcohol induces injury to the abnormal muscle, which causes it to shrink and die, forming scar tissue and relieving the obstruction to blood flow. The full benefit of the procedure is typically seen six months after the procedure.
Preparing for your Alcohol Septal Ablation Procedure
- Our team will provide you with specific instructions on preparing for your Alcohol Septal Ablation
- This will include any medications that we would like you to hold prior to the procedure
- In general, you should take all other medications as prescribed
- Activity
- It is OK to maintain your current level of activity
- If you develop symptoms, then STOP and rest
- If you develop any new symptoms, then please inform your physician
- Diet
- Small frequent meals if you have any symptoms that occur after eating
- Stay adequately hydrated
- Avoid excessive caffeine
- Avoid excess alcohol
- Make a Recovery Plan
- It is very important to plan for the following:
- Who will take me home?
- Who will stay with me the day I am discharged?
- Do I have help for preparing meals, driving, or other household chores during the first few days following the procedure?
- The day before the procedure
- You likely will be asked to have your blood drawn to have updated
- DO NOT EAT ANYTHING AFTER MIDNIGHT OR THE MORNING OF THE PROCEDURE
- It is ok to have small sips of water to take your morning medications
- It is very important to plan for the following:
- The procedure is performed at Rochester General Hospital
- You will be given specific instructions on where to go on the day of the procedure
- You will meet the cardiac anesthesiologist prior to the procedure
- Alcohol septal ablation does not require general anesthesia with a breathing tube
- Most people will receive sedation for comfort
- The procedure takes about 1-2 hours to perform
- As with any medical procedure, there are risks and anything can happen
- The most serious risks are rare but include: death, stroke, vascular complications, bleeding events requiring transfusion, arrhythmias, and/or immediate surgery
- Pacemaker implantation is the most common risk (5-10% of patients)
- We will discuss these risks with you in detail during your evaluation
- During the procedure, we typically:
- Access an artery in the leg to guide the small tube (catheter) towards the heart
- Place a temporary pacemaker through a vein in the neck to act as a backup in case you develop the need for a permanent pacemaker
- The recovery time is fast!
- Recovery occurs in our post-procedural recovery area
- You will be assigned a bed on one of our cardiac hospital floors
- Most patients are discharged in 48 hours.
- You will typically ambulate within 2 hours of the procedure
- You may experience some chest discomfort following the procedure which we will manage with pain medicine
- We also monitor your blood work (cardiac enzymes) to determine that the alcohol injury to the heart is resolving
- Our criteria for discharge is:
- You do not have any bleeding issues at the sites used for vascular access
- You can ambulate without any major limitations
- You do not have any concerning heart rhythms or require a pacemaker
- Your cardiac blood work is normalizing
- You feel well and have a recovery plan!
- We will give you detailed instructions about any restrictions and new medications following the procedure
- Some adjustments may be made to your medications.
- Most patients can resume full activity including driving 2 days after the procedure
- Your activity level should continue to improve over the next 1-6 months
- Follow-up
- You will follow up with the Hypertrophic Cardiomyopathy Clinic and have stress testing performed between 3-6 months after the procedure
- You will also (typically) undergo an echocardiogram at 30 days and again at 6 months
