Alcohol septal ablation (ASA) is a minimally invasive, nonsurgical treatment for hypertrophic cardiomyopathy. This condition causes heart tissue to thicken, restricting blood flow. For this procedure, providers use a catheter (long, thin tube) to inject alcohol in the heart’s artery. The alcohol shrinks the enlarged tissue and relieves symptoms.
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Alcohol septal ablation (ASA) is a minimally invasive procedure. Healthcare providers perform this procedure to treat a heart condition called hypertrophic cardiomyopathy. This condition causes the heart tissue to thicken and stiffen, which leads to problems with how blood pumps out of your heart.
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To perform alcohol septal ablation, healthcare providers use a long catheter (a thin, flexible tube). Through the tube, they inject alcohol into an artery that supplies blood to the small area of thickened tissue. The alcohol causes the enlarged tissue to stop contracting, which expands in the area through which blood can flow out of your heart.
Cardiologists (healthcare providers who specialize in the heart) use this minimally invasive procedure to treat hypertrophic cardiomyopathy (HCM). This heart condition is inherited (passed down through families).
HCM causes a portion of your heart muscle to thicken and stiffen. It affects the septum, or wall, that separates two of your heart’s chambers. When the wall gets too thick and stiff, it causes problems with blood flow through your heart. Your blood can’t flow from your heart to the rest of your body like it should. Decreased blood flow causes symptoms such as shortness of breath and fatigue.
Alcohol septal ablation restores normal blood flow by damaging and shrinking the thickened tissue. The procedure doesn’t harm normal tissue. Providers perform this procedure on people who have HCM and, despite medications, have symptoms of shortness of breath and/or fatigue on exertion.
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Alcohol septal ablation is a commonly used procedure to treat hypertrophic cardiomyopathy — the most common type of inherited heart disease. Healthcare providers believe about 1 of every 500 people has the condition.
Cardiologists perform this procedure more often for people over age 65 who may not be healthy enough for another treatment for HCM called septal myectomy. A type of open-heart surgery, septal myectomy uses a much larger incision and requires a longer recovery. Alcohol septal ablation is a good alternative for people who can’t have open-heart surgery.
Ask your provider what you should do to get ready for the procedure. Your provider may tell you to stop certain medications before the ASA. You’ll need to avoid eating and drinking prior to the procedure.
To evaluate your health before the procedure, your provider may order a complete blood count (CBC). To see your heart muscle in detail, they may also recommend:
You get this procedure in a hospital. It usually takes an hour or two. You’ll be awake during the procedure. But your healthcare team will give you medications to help you relax and make you more comfortable. You may also get other medications like blood thinners. During an alcohol septal ablation, your provider:
After the procedure, you’ll stay in the hospital for 48 to 72 hours. Your healthcare team will check your health and vital signs. They will give you pain relievers if you need them. They may also do imaging studies and other tests to see how blood is flowing out of your heart.
Immediately after the procedure, you’ll lie flat on your back with your legs straight if your providers used the artery at your thigh. Staying in this position helps you avoid bleeding immediately after the procedure. You may need to stay in this position for a few hours. If they accessed the vessel at your wrist, you won’t usually need to lay flat.
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During your hospital stay, one of the most important things is to continuously monitor your heart rhythm. A small percentage of people will require a pacemaker as a side effect of the ASA.
This procedure relieves symptoms of hypertrophic cardiomyopathy without the need for open-heart surgery. Since it’s minimally invasive, it involves less recovery time and fewer complications than a septal myectomy. It’s a good option for people who can’t get open-heart surgery.
For most people, alcohol septal ablation is an effective treatment. Complications aren’t common. But as with any procedure, there are risks. These include:
Though uncommon, some of these complications may require follow-up tests or treatment. People who get heart block after an ASA may need a permanent pacemaker. Talk to your provider about your risk of complications.
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Everyone’s recovery time is different. Your recovery time depends on your overall health, including whether you have cardiovascular disease or other health conditions. Ask your provider when you can return to light activity, work and exercise. Most people are able to return to usual activity within one week of the procedure.
Many people get relief from their symptoms right away after the procedure. Talk to your provider about what you can expect.
After this procedure, call your provider right away if you have:
A note from Cleveland Clinic
Alcohol septal ablation is an effective treatment for hypertrophic cardiomyopathy. This non-surgical procedure involves less recovery time and fewer complications than surgical treatments for this heart condition. Talk to your provider about what you need to do to prepare for this procedure and what you can expect during recovery. If you have any signs of complications following the procedure, get medical help right away.
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Last reviewed on 02/23/2022.
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