Septal Ablation: Non-Surgical Treatment for Hypertrophic Cardiomyopathy
TThe cardiac septum is a band of muscle that separates the two lower chambers of the heart, called the ventricles. If this muscular wall thickens, it can bulge into the left ventricle and partially block blood flow, forcing your heart to work harder to pump blood throughout your body. This condition is known as hypertrophic cardiomyopathy HCM).
Septal ablation, sometimes called alcohol or ethanol ablation, is a minimally invasive, non-surgical procedure to destroy a portion of the thickened heart tissue to shrink the septum and improve blood flow out of the heart.
Make an Appointment
Our multidisciplinary HCM team includes top rated specialists in cardiovascular medicine, cardiovascular imaging, electrophysiology, heart failure, cardiac surgery, cardiovascular genetics, interventional cardiology, maternal cardiology and pediatric cardiology. The team meets to formulate an individualized plan of care for every patient.
To schedule an appointment with a member of our hypertrophic cardiomyopathy team, please call 216-286-4426 or email HCM@UHhospitals.org.
Who Is a Good Candidate for Septal Ablation?
Septal ablation may be a good treatment option for patients with hypertrophic cardiomyopathy who:
- Cannot tolerate an open-heart procedure like septal myectomy
- Do not have other heart conditions or abnormalities that require repair or treatment
- Have only mild to moderate thickening of the septum
- Are older with additional risk factors
Preparing for Septal Ablation
Before scheduling your procedure, your interventional cardiologist will advise you how to prepare in the days leading up to the operation. You may be told to stop taking certain medications, stop smoking and drinking alcohol, and make other lifestyle modifications for a brief time prior to the procedure. For your safety, it is important to follow your doctor’s recommendations exactly.
Certain tests may also be ordered to ensure you are healthy enough to undergo the procedure. These may include blood tests, chest X-rays and heart-specific exams such as echocardiogram, electrocardiogram, cardiac catheterization or cardiac MRI. These tests may also detect other existing conditions that could affect the procedure.
The Procedure
Septal ablation takes 1 – 2 hours or more and is usually done in a cardiac catheterization lab. Patients may be put under general anesthesia or remain awake depending on their clinical condition.
After numbing the area with local anesthetic, the doctor inserts a small flexible tube (catheter) into an artery or vein in the groin. Using advanced image-guidance, the catheter is threaded through the blood vessels until it reaches the heart. A small amount of pure alcohol is injected into the artery that supplies blood to the upper part of the septum. The alcohol destroys the targeted tissue on contact, causing the septum to shrink over time and widen the left ventricle to improve blood flow out of the heart.
The catheter is then carefully removed and the tiny incision in the groin is bandaged.
Recovery after Septal Ablation
After the procedure, the patient is moved into the cardiac intensive care unit (CICU) where they are monitored for several hours. To help prevent bleeding, the patient will be required to lie flat during this time.
Once the patient is fully awake and their vital signs are normal, they remain in the CICU for observation and monitoring for up to three days. Additional time in the hospital may be required depending on the individual patient and their recovery progress. Some medications stopped prior to the procedure, may be resumed while still in the hospital, with the doctor’s approval.
Light activity and exercise can usually resume after a short time with the doctor’s approval.
Risks and Benefits of Septal Ablation
Septal ablation is a highly effective treatment for hypertrophic cardiomyopathy in select patients. Although most will notice immediate improvement of their symptoms, others may continue to experience some symptoms for a short time as the ablated muscle heals and remodels.
Even though septal ablation is a very safe, minimally invasive procedure there are some risks. The most common risk is heart block – a slow heart rate caused by a disruption in electrical signals in the heart. In some cases, a permanent pacemaker may be need to resolve the problem. Another potential but minor risk is bleeding at the site where the catheter was inserted.
With current techniques, the risk of blood clots, heart attack and stroke is extremely rare.
Before scheduling this procedure, patients should discuss the risks and benefits with their doctor.
Local Access to World-Class Expertise
The hypertrophic cardiomyopathy team at University Hospitals Harrington Heart & Vascular Institute has the advanced training and experience needed to perform a wide range of complex heart surgeries and procedures, including septal ablation.
Our expert, multidisciplinary teams work together to provide patients with a safe, seamless experience from preparation and pre-op testing, to day-of-procedure navigation and support, through recovery, discharge and rehabilitation.