Alcohol septal ablation (ASA) is performed percutaneously (through the skin) to reduce overgrown heart muscle due to hypertrophic cardiomyopathy, a disorder that affects the heart muscle’s ability to pump blood effectively. This procedure is performed by an interventional cardiologist in a cardiac catheterization laboratory.
Board-certified cardiovascular medicine specialists at Brigham and Women’s Hospital (BWH) are high-volume proceduralists in all types of cardiac procedures including alcohol septal ablation. This experience and their collaboration with a multidisciplinary team of specialists through the Interventional Cardiology Program enable our doctors to handle the most complicated cases, with a range of treatment options that improve the lives of cardiac patients throughout the world.
With 47,000 outpatient visits each year, the BWH Heart & Vascular Center is the largest in the United States, treating over 7,000 inpatients and performing more than 8,000 procedures annually at our state-of-the-art Shapiro Cardiovascular Center.
This minimally invasive procedure involves light sedation, followed by the slow injection of 100 percent alcohol via catheter into one of the branches of the heart artery that leads to the enlarged septum. The high concentration of alcohol (1-3 ml) is delivered directly to the thickened heart muscle and left in place for several minutes. Thin scar tissue forms and starts to improve blood flow to and away from the heart.
During the procedure, the interventional cardiologists observe the heart from all sides via X-ray fluoroscopy and echocardiography. This enables monitoring correct catheter placement and the destruction of only the necessary cells to reduce the thickening heart mass.
A small percentage of patients (five to ten percent) can develop significant slowing of the heart rate (complete heart block) and, thus, a temporary pacemaker is inserted to the heart from the neck and is left for one-two days post procedure.
An alcohol septal ablation is performed in the cardiac catheterization laboratory (or cath lab) by the interventional cardiologist and a team of cardiovascular nurses and technicians. The procedure usually lasts about two hours, but the preparation and recovery time add several hours. You may stay in the hospital for several days to be observed by the medical staff.
Alcohol septal ablation relieves symptoms and improves functional status in severely symptomatic patients with hypertrophic cardiomyopathy who meet clinical, anatomic and physiologic selection criteria. Many patients may be better treated with surgery, however in carefully selected patients for alcohol ablation, the procedure is successful in relieving symptoms in over 90 percent of patients.
The BWH Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH’s main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.
Prior to your procedure, you will likely be scheduled for a visit to the Watkins Clinic in the Shapiro Cardiovascular Center for preoperative information and tests.
The day of the procedure, your care will be provided by cardiologists, anesthesiologists and nurses who specialize in ablations. After your procedure, you will recover in the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.
During your procedure, family and friends can wait in the Shapiro Family Center where staff members will provide updates.
In addition to our cardiovascular medicine specialists, patients also benefit from the teamwork of interventional cardiologists, cardiovascular imaging experts and radiologists, and anesthesiologists, all experts in cardiac disorders. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.