Alcohol septal ablation (ASA) is a minimally invasive interventional procedure used in the treatment of hypertrophic obstructive cardiomyopathy (HOCM). In this procedure, alcohol is injected into the thickened septal muscle to create controlled damage and reduce left ventricular outflow tract obstruction.
What is Hypertrophic Cardiomyopathy?#
Hypertrophic cardiomyopathy (HCM) is a genetic disease characterized by abnormal thickening of the heart muscle. It is seen in approximately 1/500 of the general population.
Hypertrophic Obstructive Cardiomyopathy (HOCM):
- Seen in approximately 70% of HCM patients
- Thickened septum narrows the left ventricular outflow tract
- Blood flow is obstructed
- Symptoms appear
HOCM Symptoms#
Symptoms of obstructive hypertrophic cardiomyopathy:
- Shortness of breath: Especially with exertion
- Chest pain: Angina-like
- Palpitations: Due to arrhythmias
- Dizziness/fainting: Especially with exertion
- Fatigue: Limitation in daily activities
⚠️ Important: HOCM is one of the most common causes of sudden cardiac death in young athletes!
Diagnosis#
Echocardiography#
Primary imaging method in HOCM diagnosis:
- Septal thickness (≥15 mm)
- Left ventricular outflow tract gradient (≥30 mmHg)
- Systolic anterior motion (SAM)
- Mitral regurgitation
Cardiac MRI#
For detailed evaluation:
- Myocardial thickness
- Fibrosis (late gadolinium enhancement)
- Sudden death risk assessment
Genetic Testing#
Genetic testing is recommended for family screening and risk assessment.
Treatment Options#
Medical Treatment#
First-line treatment:
- Beta blockers
- Calcium channel blockers (verapamil)
- Disopyramide
- Mavacamten (new generation)
Septal Myectomy#
Surgical treatment option:
- Open heart surgery
- Surgical removal of thickened septum
- Gold standard (in experienced centers)
Alcohol Septal Ablation (ASA)#
Minimally invasive alternative:
- Catheter-based procedure
- Patients unsuitable for surgery
- Equivalent long-term results
How is Alcohol Septal Ablation Performed?#
Pre-Procedure Preparation#
- Comprehensive echocardiographic evaluation
- Coronary angiography
- Determination of septal artery anatomy
- Temporary pacemaker placement
Procedure Steps#
- Coronary angiography: Imaging of septal arteries
- Target artery selection: Septal artery supplying the area causing obstruction
- Balloon placement: Balloon catheter to selected septal artery
- Contrast echo: Confirmation that balloon is in correct position
- Alcohol injection: 1-3 ml pure alcohol injected slowly
- Waiting: Balloon remains inflated for 5-10 minutes
- Control: Gradient measurement and echocardiography
Post-Procedure#
- Intensive care monitoring (24-48 hours)
- Rhythm monitoring
- Enzyme monitoring (troponin rises)
- Temporary pacemaker (AV block risk)
ASA Results#
Expected results after successful ASA:
Short Term:
- Gradient reduction (50-70%)
- Symptom improvement
- Increase in exercise capacity
Long Term:
- Septal thinning (within 3-6 months)
- Permanent gradient reduction
- Significant improvement in quality of life
ASA Risks and Complications#
Procedure risks:
- AV block (10-20%): May require permanent pacemaker
- Ventricular arrhythmia: Rare
- Coronary artery damage: Very rare
- Myocardial infarction: Controlled (expected)
- Death: <1%
ASA or Myectomy?#
Both treatments have advantages:
| Feature | ASA | Myectomy |
|---|---|---|
| Invasiveness | Minimal | Open surgery |
| Anesthesia | Local/sedation | General |
| Recovery | Fast | Longer |
| AV block risk | Higher | Lower |
| Gradient reduction | Gradual | Immediate |
| Repeat procedure | Possible | Rare |
The decision is made individually based on patient anatomy, age, and preference.
Frequently Asked Questions#
Is alcohol septal ablation painful?
Is a permanent pacemaker needed after ASA?
When is improvement seen after ASA?
What is done if ASA fails?
Can I exercise after ASA?
Appointment and Contact#
If you would like to schedule an appointment for hypertrophic cardiomyopathy evaluation or treatment:
📍 Avrasya Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul
📞 Phone: +90 212 665 50 50 (Ext: 4012)
This content has been prepared by Assoc. Prof. Dr. Habib Çil for general informational purposes. Please consult a cardiology specialist for definitive diagnosis and treatment.
Related Cardiology Treatments#
Other treatments related to alcohol septal ablation:
- Echocardiography - Heart ultrasound
- Heart Failure - Heart failure treatment
- Cardiac Angiography - Coronary artery imaging
- ICD - Implantable cardioverter defibrillator
- Permanent Pacemaker - Bradycardia treatment