Alcohol Septal Ablation
Alcohol Septal Ablation or ASA is performed in the cardiac catheterization laboratory under standard conditions for a left heart catheterization. A catheter is passed (guided by radiology and echocardiography) through the large artery in the groin up to the artery that feeds the enlarged septum. Once the proper artery is identified, alcohol is injected into the area in order to induce a small, controlled heart attack in the obstructive tissue. If successful, this tissue scars and shrinks backs to normal size, thereby relieving the obstruction. The patient spends one night in ICU, a second night in a regular hospital room and is then discharged home for two weeks rest. After two weeks the patient can resume normal activities. The largest complication associated with this procedure is the need for a permanent pacemaker in about 10% of patients. Other complications can include bleeding, infection and damage the heart arteries.
Almost all patients who have had alcohol ablation report some immediate relief of shortness of breath, with complete improvement of all symptoms in the months to follow. About 10% of patients require a second treatment for complete relief of symptoms. Sometimes ASA can be difficult or impossible to perform related to specific factors that affect the ability to pass a catheter into the appropriate artery. At the Methodist DeBakey Heart Center, a magnetic guidance system is used to guide the catheters in these situations making the procedure possible in such cases. Dr. John Buergler was the first physician in the United States to use this system to aid in the treatment of patients with HOCM.