Alcohol Septal Ablation
For patients with coronary artery disease, specifically those with hypertophic 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 Heart, and specifically The Mount Sinai Hospital’s Cardiac Cathetorization Lab is one of relatively few high-volume centers offering a fourth choice.
Alcohol septal ablation (ASA), a 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 surgery. ASA is now the second treatment option for HOCM patients who are on maximum medical therapy. We also employ ASA for elderly women with hypertension who have mid-cavitary obstruction in HOCM.
Our interventional cardiologists perform ASA percutaneously 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. We deliver a high concentration of alcohol (1-3ml) directly to your thickened heart muscle and leave it 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 to 10 percent) 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 a day or two after the ASA.
Working in a cardiac catheterization lab, our interventional cardiologists can 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.
Once you have undergone ASA, we monitor you closely in our 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). You will likely feel better almost immediately, and once safely stabilized, you will be able to return home on restricted activity for two to four weeks. We conduct follow-up echocardiograms three to six months later.