Hypertrophic heart disease: what is alcohol septal ablation (ASA)?

By Cristiano Antonino On Mar 3, 2023

Alcohol septal ablation (ASA) is a minimally invasive, nonsurgical treatment for hypertrophic cardiomyopathy

This condition causes heart tissue to thicken, restricting blood flow.

For this procedure, providers use a catheter (long, thin tube) to inject alcohol in the heart’s artery.

The alcohol shrinks the enlarged tissue and relieves symptoms.

What is alcohol septal ablation?

Alcohol septal ablation (ASA) is a minimally invasive procedure.

Healthcare providers perform this procedure to treat a heart condition called hypertrophic cardiomyopathy.

This condition causes the heart tissue to thicken and stiffen, which leads to problems with how blood pumps out of your heart.

To perform alcohol septal ablation, healthcare providers use a long catheter (a thin, flexible tube).

Through the tube, they inject alcohol into an artery that supplies blood to the small area of thickened tissue.

The alcohol causes the enlarged tissue to stop contracting, which expands in the area through which blood can flow out of your heart.

Why do providers perform alcohol septal ablation?

Cardiologists (healthcare providers who specialize in the heart) use this minimally invasive procedure to treat hypertrophic cardiomyopathy (HCM). This heart condition is inherited (passed down through families).

HCM causes a portion of your heart muscle to thicken and stiffen.

It affects the septum, or wall, that separates two of your heart’s chambers.

When the wall gets too thick and stiff, it causes problems with blood flow through your heart.

Your blood can’t flow from your heart to the rest of your body like it should.

Decreased blood flow causes symptoms such as shortness of breath and fatigue.

Alcohol septal ablation restores normal blood flow by damaging and shrinking the thickened tissue.

The procedure doesn’t harm normal tissue.

Providers perform this procedure on people who have HCM and, despite medications, have symptoms of shortness of breath and/or fatigue on exertion.

How common is alcohol septal ablation?

Alcohol septal ablation is a commonly used procedure to treat hypertrophic cardiomyopathy — the most common type of inherited heart disease.

Healthcare providers believe about 1 of every 500 people has the condition.

Cardiologists perform this procedure more often for people over age 65 who may not be healthy enough for another treatment for HCM called septal myectomy.

A type of open-heart surgery, septal myectomy uses a much larger incision and requires a longer recovery.

Alcohol septal ablation is a good alternative for people who can’t have open-heart surgery.

What happens before alcohol septal ablation?

Ask your provider what you should do to get ready for the procedure.

Your provider may tell you to stop certain medications before the ASA.

You’ll need to avoid eating and drinking prior to the procedure.

To evaluate your health before the procedure, your provider may order a complete blood count (CBC).

To see your heart muscle in detail, they may also recommend:

Echocardiogram, an imaging study that monitors your heartbeat.
Electrocardiogram (EKG) to monitor your heart’s electrical activity.
Imaging studies such as a chest X-ray.

What happens during alcohol septal ablation?

You get this procedure in a hospital. It usually takes an hour or two.

You’ll be awake during the procedure.

But your healthcare team will give you medications to help you relax and make you more comfortable.

You may also get other medications like blood thinners.

During an alcohol septal ablation, your provider:

Injects medication (with a needle) to numb the area around your wrist or at the top of your thigh.
Inserts a thin, flexible tube called a catheter into the area above. They thread the catheter through blood vessels that lead to your heart.
Monitors the location of the catheter using X-ray images.
Injects alcohol called isopropyl alcohol into the catheter. The alcohol enters your heart through the artery. As the alcohol flows into the heart muscle, it causes the abnormally thick cells to die. You may feel some discomfort during this part of the procedure.
Pulls the catheter out of the artery.
Uses a compression bandage at your wrist or stitches at your thigh to close the opening in your artery.

During the procedure, a temporary pacemaker wire is also inserted via the vein in your neck.

This stays in place for 48 to 72 hours after the procedure while your care team monitors your heart rhythm.

What happens after alcohol septal ablation?

After the procedure, you’ll stay in the hospital for 48 to 72 hours.

Your healthcare team will check your health and vital signs.

They will give you pain relievers if you need them.

They may also do imaging studies and other tests to see how blood is flowing out of your heart.

Immediately after the procedure, you’ll lie flat on your back with your legs straight if your providers used the artery at your thigh.

Staying in this position helps you avoid bleeding immediately after the procedure

You may need to stay in this position for a few hours.

If they accessed the vessel at your wrist, you won’t usually need to lay flat.

During your hospital stay, one of the most important things is to continuously monitor your heart rhythm.

A small percentage of people will require a pacemaker as a side effect of the ASA.

What are the advantages?

This procedure relieves symptoms of hypertrophic cardiomyopathy without the need for open-heart surgery.

Since it’s minimally invasive, it involves less recovery time and fewer complications than a septal myectomy.

It’s a good option for people who can’t get open-heart surgery.

What are the risks or complications?

For most people, alcohol septal ablation is an effective treatment.

Complications aren’t common.

But as with any procedure, there are risks.

These include:

Bleeding or infection where the catheter entered your arm, leg or neck. Ask your provider about incision care after the procedure.
Blood clots, which are gel-like collections of blood that can develop in your blood vessels.
Damage or tears to the heart These tears may require surgical repair.
Heart block, which is a problem with the electrical signals in the heart. This complication can make your heart beat too slowly or too fast and could require a pacemaker.
Pericardial effusion, which is a condition where fluid builds up around the heart.

Though uncommon, some of these complications may require follow-up tests or treatment.

People who get heart block after an ASA may need a permanent pacemaker.

Talk to your provider about your risk of complications.