Alcohol Septal Ablation
For patients with hypertrophic obstructive cardiomyopathy (HOCM), traditional treatments have included pharmacologic agents such as beta-blockers that slow the heart rate and increase its ability to fill, pacemakers to alter the pattern of contraction to one that is more efficient (no longer a preferred treatment modality), and open heart surgery to remove overgrown heart muscle to enhance blood flow from the left ventricle. Mount Sinai's Cath Lab is one of relatively few high-volume centers offering those with symptomatic obstructive HOCM a fourth choice.
Known as alcohol septal ablation (ASA), this minimally invasive procedure does not require general anesthesia or a lengthy recovery time, and is only rarely associated with complications sometimes found in open heart septal myectomy. ASA is now the second treatment option for the selected group of HOCM patients, who are on maximum medical therapy. Mount Sinai also employs ASA for the small group of elderly women with hypertension who have mid-cavitary obstruction in HOCM.
About the Alcohol Septal Ablation Interventional Procedure and Our Outcomes
ASA is performed percutaneously by an interventional cardiologist in the cardiac catheterization laboratory to remove the overgrown heart muscle. This minimally invasive procedure involves light sedation, followed by the slow injection of 100 percent alcohol via catheter into one of the branches of the heart artery that leads to the enlarged septum. The high concentration of alcohol (1-3 ml) is delivered directly to the thickened heart muscle and left in place for several minutes. The effect of the controlled cell death at the targeted location is immediate, as thin scar tissue starts to improve blood flow to and away from the heart. A small percentage of patients (5-10 percent) can develop significant slowing of the heart rate (complete heart block) and, hence, a temporary pacemaker is always inserted to the heart from the neck and is left for 1-2 days post ASA.
Our interventional cardiologists are able to watch the heart from all sides via X-ray fluoroscopy and echocardiography. This enables us to monitor correct catheter placement and the destruction of only the necessary cells to reduce the thickening heart mass. Thanks to our extreme care in selecting patients and adhering to strict protocols, our complication rate for ASA has been zero over the last three years.
Post Alcohol Septal Ablation Care
Patients who have undergone ASA are closely monitored in Mount Sinai's Cath Lab ICU for two days following the procedure. Our team is particularly attentive to arrhythmias, heart blocks and blood chemistry, tracking volume of creatine kinase (enzyme) leakage to indicate the extent of the controlled damage (normal leakage range is 700 to 1,500 enzyme units per liter). Patients typically report feeling better almost immediately, and once safely stabilized, they are able to return home on restricted activity for two to four weeks. Follow-up echocardiograms are then conducted three to six months later.