Alcohol septal ablation was first performed at London's Royal Brompton Hospital in 1994 as an alternative to surgery in patients suffering from hypertrophic obstructive cardiomyopathy. The condition is caused by a thickening of the muscle wall between the left and right ventricles of the heart. Surgical resection of the excess material requires the administration of a general aesthetic and a long recovery time, while the alcohol ablation method is done without general anesthesia, and patients recover much more quickly.
Drug Therapy
Prior to undergoing alcohol septal ablation, patients often complete a course of drug therapy using a beta blocker such as propranolol. If drug therapy fails, the two remaining options are surgery and alcohol septal ablation. Candidacy for the non-invasive alcohol ablation is determined by a number of factors, including the presence of outward symptoms such as shortness of breath and chest pain, the degree of the obstruction measured both at rest and under the stress of exercise, and a patient's age.
Pre-op
Patients are given a local anesthetic at the point of insertion near the groin and a medication to help them relax, but they are not put under general anesthetic. Doctors will perform an EKG to get a baseline before the procedure begins and check the blood for cardiac markers. These checks continue throughout the process.
Insertion
Two tubes are inserted into the groin area; one in the vein and one in the artery. The vein leads the tube to the right ventricle, where the doctor will place a temporary pacemaker. A balloon catheter is inserted through the artery traveling to the left ventricle.
Ablation
Once the balloon is in place and the location of the enlarged septum is in range, the balloon is inflated to block the blood flow through the artery and 3 to 5 cc of alcohol is injected into the site. The alcohol deadens the excess heart muscle, which will then thin out after the procedure.
Post-op
The patient undergoes an angiography to determine the effect of the procedure. This involves inserting a catheter tipped with a camera through the artery to view the area. If the doctor is satisfied, the catheters are removed and he will perform gradient pressure tests to ensure that the obstruction has been eliminated. The recovery time averages two days for a successful procedure with no complications. Patients are monitored closely in the cardiac unit.
