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Review
. 2021 May 24;10(11):2276.
doi: 10.3390/jcm10112276.

Alcohol Septal Ablation: An Option on the Rise in Hypertrophic Obstructive Cardiomyopathy

Victor Arévalos  1   2 , Juan José Rodríguez-Arias  1   2 , Salvatore Brugaletta  1   2 , Antonio Micari  3 , Francesco Costa  3 , Xavier Freixa  1   2 , Mónica Masotti  1   2 , Manel Sabaté  1   2 , Ander Regueiro  1   2
Affiliations
Review

Alcohol Septal Ablation: An Option on the Rise in Hypertrophic Obstructive Cardiomyopathy

Victor Arévalos et al. J Clin Med. .

Abstract

Hypertrophic cardiomyopathy (HCM) can cause symptoms due to the obstruction of the left ventricle outflow tract (LVOT). Although pharmacological therapy is the first step for treating this condition, many patients do not fully respond to the treatment, and an invasive approach is required to manage symptoms. Septal reduction therapies include septal myectomy (SM) and alcohol septal ablation (ASA). ASA consists of a selective infusion of high-grade alcohol into a septal branch supplying the basal interventricular septum to create an iatrogenic infarction with the aim of reducing LVOT obstruction. Currently, SM and ASA have the same level of indication; however, ASA is normally reserved for patients of advanced age, with comorbidities or when the surgical approach is not feasible. Recent data suggests that there are no differences in short- and long-term all-cause mortality, cardiovascular mortality and sudden cardiac death between ASA and SM. Despite the greater experience and refinement of the technique gained in recent years, the most common complication continues to be complete atrio-ventricular block, requiring a permanent pacemaker. Septal reduction therapies should be performed in experienced centres with comprehensive programs.

Keywords: alcohol septal ablation; hypertrophic obstructive cardiomyopathy; septal myectomy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Balance between SM and ASA in the decision-making process.
Figure 2
Figure 2
Main steps of the ASA technique performed in a patient at our center. (a) An extra back-up (EBU) catheter was placed on the ostium of the left main (black arrow); a pig-tail catheter was placed in the left ventricle (LV) for gradient monitoring (red arrow); temporary pacemaker (PM) electro-catheter was placed on the right ventricle (RV) (white arrow). (b) Coronary angiogram showing absence of atheroscletic lesions and the origin of the first septal branch (black arrow). LAD: left anterior descending. (c) The first septal branch is wired and an over-the-wire (OTW) balloon is advanced to this artery (black arrow). (d) Transthoracic echocardiography (TTE) showing hypertrophy of the basal septum (white arrow), which makes contact during systole with the anterior leaflet of mitral valve (red arrow). (e) TTE performed after Gelafundin® (B. Braun, Melsungen, Germany) injection in the septal branch; enhancement of the basal septum can be seen (white arrows), this indicates that the first septal is suitable for ablation. (f) Coronary angiogram showing final result with occlusion of the first septal branch after alcohol injection.
See this image and copyright information in PMC

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