Alcohol septal ablation

Alcohol septal ablation is a minimally invasive structural heart disease treatment to treat hypertrophic cardiomyopathy (HCM), a condition that causes thickening in the septum that divides your right and left heart chambers.

In alcohol septal ablation, an interventional cardiologist injects alcohol into the blood vessel that supplies blood to your septum. The alcohol causes the thickened heart tissue to shrink, improving blood flow. Because this procedure doesn’t require open-heart surgery, people typically recover quickly, with few complications.

The thickening of the septum caused by HCM makes it difficult for your heart to pump blood out to your body. It also puts extra pressure on your heart, leading to fatigue and shortness of breath. Without treatment, HCM may lead to heart failure.

Many people with HCM can manage the condition with medications. If medications aren’t effective, your provider may recommend alcohol septal ablation. Alcohol septal ablation may also be appropriate for older patients and those with less severe heart thickening.

Patients who aren’t good candidates for a septal myectomy may also be candidates for alcohol septal ablation. A septal myectomy is an open-heart surgery in which a cardiac surgeon removes thickened heart tissue. Older patients or those with several underlying health conditions may not be good candidates for open-chest surgeries.

Your care team gives you specific instructions to prepare for alcohol septal ablation. You may need to stop taking certain medications, such as beta blockers, for a brief period before the procedure. You’ll also need to avoid eating or drinking anything after midnight on the day of your procedure.

Your care team may also order tests to evaluate your heart, including:

• Chest X-ray to look at your heart’s structure
• Echocardiogram to look at your heart’s anatomy and blood flow
• Electrocardiogram to check your heart rhythm

Alcohol septal ablation is an inpatient procedure that takes one to two hours. We perform the procedure in our cardiac catheterization laboratory (cath lab), which houses the latest technology and imaging tools. You’ll likely remain awake during the procedure with sedation to help you remain comfortable and calm.

During the procedure, an interventional cardiologist:

1. Makes a tiny incision in your groin or wrist and inserts a flexible, hollow tube (catheter) into a blood vessel
2. Uses X-ray guidance to direct the catheter to the artery supplying blood to your septum
3. Injects alcohol through the catheter
4. Inserts a temporary pacemaker that stays in place for a few days to prevent a slowed heart rate (bradycardia)
5. Removes the catheter and closes the incision site

Alcohol septal ablation offers a minimally invasive alternative to open-heart surgery. Open-heart surgeries involve making a large incision to open the chest and breastbone. These surgeries can be painful and recovery may be long.

Alcohol septal ablation uses only a tiny incision where the catheter is inserted. Patients experience less blood loss and recover more quickly, including spending less time in the hospital.

Because alcohol septal ablation is minimally invasive, complications are rare. However, all medical procedures carry some risk. Potential risks associated with alcohol septal ablation include:

• Arrhythmias (irregular heart rhythms)
• Bleeding
• Blood clots
• Fluid buildup around the heart
• Heart block, an interruption in your heart’s electrical signals that can cause a slow heart rate
• Infection

Our team monitors you carefully after the procedure to look for signs of complications and provide rapid treatment if necessary.

You may need to stay in the hospital for up to 72 hours for monitoring after alcohol septal ablation.

Most people experience rapid symptom relief after alcohol septal ablation. Your overall recovery time depends on multiple factors, including your overall health and whether you have heart disease. Your provider gives you specific instructions about when you can return to usual activities, usually within a week or two.

After alcohol septal ablation, your provider may recommend you complete cardiac rehabilitation. Cardiac rehab can help strengthen your heart and speed your recovery. Our rehabilitation specialists provide education, nutrition counseling, and gentle exercises in an outpatient setting.

Specialists in Penn Medicine’s Interventional Cardiology Program have a long history of innovation and excellence in minimally invasive heart procedures. When you choose our team, you benefit from:

• Experienced physicians: Penn Medicine is among the highest-volume programs in the nation for alcohol septal ablation, setting our physicians apart as experts in this treatment.
• Exclusive treatment: Penn is one of only a few centers in the Philadelphia region to offer alcohol septal ablation. You get leading-edge care, without having to travel far.
• Specialized experts, excellent outcomes: Our multidisciplinary team approach involves the expertise of interventional cardiologists who specialize in structural heart diseases, experts in heart surgery, specialists in the Center for Inherited Cardiovascular Disease, interventional echocardiographers, and specialized nurses. Their training allows us to offer more advanced treatments with excellent outcomes.