Septal ablation

Septal ablation involves injecting an alcohol solution into the heart, purposely causing a strategically localized "heart attack" to treat the symptoms of hypertrophic obstructive cardiomyopathy (HOCM) by destroying a small area of the muscle. As a new procedure, developed over the past decade, septal ablation is considered experimental by the American Heart Association. Although this procedure is performed using heart catheterization as opposed to open-heart surgery, it is no safer than a myectomy. It's too soon to estimate the long-term benefits and safety issues of septal ablation therapy.

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Septal ablation is a heart catheterization procedure that usually lasts between one and two hours. Patients are awake and able to talk throughout the procedure, although they may be given sedatives to help them relax. Catheters are used to implant a temporary pacemaker, as a safety measure, and to perform an angiography to visualize the blood vessels and small arteries of the heart that carry blood to the overgrown muscle that is causing the obstruction. Once the blood vessels of the overgrown area have been identified, alcohol is injected into the catheter to destroy the tissue in the overgrown area of the heart muscle as shown in Figure 6. Over time, the tissue scars and shrinks, decreasing the obstruction to blood flow and improving the symptoms of HOCM.

While this procedure is relatively new, information from research studies suggests that septal ablation can, in appropriately chosen patients, relieve symptoms to a similar degree as septal myectomy. The success of the treatment largely depends on the ability of the cardiologist to correctly identify and isolate the area of the heart causing the obstruction. Approximately 5 percent to 10 percent of the patients undergoing a septal ablation will need a pacemaker due to damage of the conduction system of the heart resulting from the procedure. In addition, the procedure is too new for long-term outcomes to be understood. There may be unknown safety issues, such as long-term risks of abnormal and potentially lethal heart rhythms associated with scarring of the heart muscle.

Although many centers are equipped with heart catheterization facilities, it can be very difficult to control the extent of the "heart attack" within the heart muscle. Septal ablation should be performed only by an experienced cardiologist specializing in this procedure.

Not all people with HOCM are candidates for septal ablation. The unique anatomy of each individual heart must be considered; the anatomies of some hearts are not conducive to septal ablation treatment. For some people, there may be other health concerns to consider that preclude the use of this treatment. On the other hand, septal ablation is a good alternative for people who are not candidates for surgery or do not want to undergo heart surgery.