Patient education: Alcohol septal ablation (The Basics)

What is alcohol septal ablation? — 

This is a procedure to treat hypertrophic cardiomyopathy, or "HCM." HCM is a condition that causes the muscle between the lower chambers of the heart, called the "septum," to get too thick (figure 1). When this happens, the heart can have trouble pumping blood as well as it should.

Alcohol septal ablation is a way to treat the thick area of the heart without having to do open heart surgery. It involves injecting a special kind of alcohol into 1 of the arteries that bring blood to the heart muscle. Over time, the alcohol causes the septum to become thinner. Then, blood can flow more easily through the lower chambers of the heart.

How do I prepare for alcohol septal ablation? — 

The doctor or nurse will tell you if you need to do anything special to prepare.

Before the procedure, your doctor will do an exam. They might send you to get tests, such as:

●Blood tests – These include tests to check kidney function and red and white blood cell counts.

●Electrocardiogram ("ECG") – This measures the electrical activity in the heart.

●Echocardiogram – This uses sound waves to create images of the heart as it beats.

Your doctor will also ask about your "health history." This involves asking about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes prescription and "over-the-counter" medicines, plus any herbal supplements. It helps to write down and bring a list of your medicines, or bring a bag with all your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before the procedure – You might need to "fast" before the procedure. This means not eating or drinking anything for a period of time. Or you might be allowed to have liquids until a short time before the procedure. Whether you need to fast and for how long depends on the procedure.

●If you need to temporarily stop any medicines before the procedure

●What help you will need when you go home – For example, you might need someone else to bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during alcohol septal ablation? — 

When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will be awake during the procedure, but the doctor will give you "sedative" medicine to help you feel relaxed. You will also get "local anesthesia." This is medicine to numb a small part of your body so you don't feel pain.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make a very small cut ("incision") in the top inner part of your leg, or in your wrist.

●They will do a procedure called "cardiac catheterization," or "cardiac cath." For this, they put a thin, plastic tube called a "catheter" in a blood vessel just below the incision. Then, they gently push the tube through your blood vessels to your heart (figure 2). You will not be able to feel this.

●While this is happening, an X-ray will take pictures of the catheter in your body. This helps the doctor know when the tube reaches the correct place in your heart.

●The doctor might put in a temporary pacemaker. This is a device that can keep your heartbeat normal. The alcohol injection can damage the part of your heart that controls how often your heart beats.

●The doctor will inject a special kind of alcohol into 1 of your arteries that bring blood to your heart muscle. You might feel some discomfort or a sense of uneasiness during this part.

●When finished, the doctor will remove the catheter. They will hold pressure or use stitches, skin glue, or medical tape to close your incision and stop any bleeding. They will cover the incision with a bandage.

●Alcohol septal ablation usually takes about 1 to 2 hours.

What happens after alcohol septal ablation? — 

You will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Most people stay in the hospital for a few days after.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●The staff will watch your heart rate and rhythm closely. You might still have the temporary pacemaker while you are in the hospital.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine to help with pain, if needed. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of alcohol septal ablation? — 

Your doctor will talk to you about all the possible risks and answer your questions. Possible risks include:

●Bleeding, bruising, or an infection where the catheter was put in

●Blood clots, or damage to blood vessels

●Irregular heartbeat, stroke, or heart attack

●Needing a permanent pacemaker

●Continuing heart problems

What else should I know? — 

Before you go home from the hospital, make sure you know what problems to look out for and when to call the doctor. Make sure you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Alcohol septal ablation – Discharge instructions (The Basics)
Patient education: Hypertrophic cardiomyopathy in adults (The Basics)
Patient education: Hypertrophic cardiomyopathy in children (The Basics)
Patient education: Cardiac catheterization (The Basics)
Patient education: Pacemakers (The Basics)

Patient education: Hypertrophic cardiomyopathy (Beyond the Basics)
Patient education: Pacemakers (Beyond the Basics)