Since 1994, alcohol septal ablation (ASA) has been used as a minimally invasive treatment of patients with hypertrophic obstructive cardiomyopathy, resistant to conservative medical therapy. This catheter-based intervention consists of injecting absolute alcohol in a septal perforator to induce infarction of the hypertrophied septum and thus diminish the left ventricle outflow tract obstruction. This reduction of the gradient is associated with reduction of symptoms and left ventricle remodeling. The procedure was improved after the introduction of myocardial contrast echocardiography for visualization of the area at risk of infarction and reduction of the alcohol amount. Major complications of ASA are rare but centers with experience have reported conduction disorders - about 10% of patients needed permanent pacing because of complete AV block. Large randomized prospective studies have not yet compared alcohol septal ablation to the gold standard for treatment of hypertrophic obstructive cardiomyopathy - surgical myomectomy.
If the inline PDF is not rendering correctly, you can download the PDF file here.
1. Maron BJ McKenna WJ Danielson GK Kappenberger LJ Kuhn HJ Seidman CE et al. American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines. J Am Coll Cardiol. 2003;42(9):1687-713.2).
2. Maron BJ Dearani JA Ommen SR Maron MS Schaff HV Gersh BJ et al. The case for surgery in obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol. 2004;44(10):2044-53.
3. Holmes DR Jr. Valeti US Nishimura RA. Alcohol septal ablation for hypertrophic cardiomyopathy: indications and technique. Catheter Cardiovasc Interv. 2005;66(3):375-89.
4. Singh M Edwards WD Holmes DR Jr Tajil AJ Nishimura RA. Anatomy of the first septal perforating artery: a study with implications for ablation therapy for hypertrophic cardiomyopathy. Mayo Clin Proc. 2001;76(8):799-802.
5. Faber L Ziemssen P Seggewiss H. Targeting percutaneous transluminal septal ablation for hypertrophic obstructive cardiomyopathy by intraprocedural echocardiographic monitoring. J Am Soc Echocardiogr. 2000;13(12):1074-9.
6. Monakier D Woo A Puri T Schwartz L Ross J Jamorski M et al. Usefulness of myocardial contrast echocardiographic quantification of risk area for predicting postprocedural complications in patients undergoing septal ethanol ablation for obstructive hypertrophic cardiomyopathy. Am J Cardiol. 2004;94(12):1515-22.
7. Faber L Seggewiss H Welge D Fassbender D Schmidt HK Gleichmann U et al. Echo-guided percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy: 7 years of experience. Eur J Echocardiogr. 2004;5(5):347-55.
8. Chang SM Nagueh SF Spencer WH 3rd Lakkis NM. Complete heart block: determinants and clinical impact in patients with hypertrophic obstructive cardiomyopathy undergoing nonsurgical septal reduction therapy. J Am Coll Cardiol. 2003;42(2):296-300.
9. Kuhn H Lawrenz T Lieder F Leuner C Strunk-Mueller C Obergassel L et al. Survival after transcoronary ablation of septal hypertrophy in hypertrophic obstructive cardiomyopathy (TASH): a 10 year experience. Clin Res Cardiol. 2008;97(4):234-43.
10. Bhagwandeen R Woo A Ross J Wigle ED Rakowski H Kwinter J et al. Septal ethanol ablation for hypertrophic obstructive cardiomyopathy: early and intermediate results of a Canadian referral centre. Can J Cardiol. 2003;19(8):912-7.
11. Veselka J Duchonová R Procházková S Homolová I Pálenícková J Zemánek D et al. The biphasic course of changes of left ventricular outflow gradient after alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Kardiol Pol. 2004;60(2):133-6.
12. Sorajja P Valeti U Nishimura R Ommen S Rihal C Gersh B. Outcome of Alkohol septal ablation of obstructive hypertrophic cardiomiopaty. Circulation. 2008;118:131-139.
13. Angelini P. The “1st septal unit” in hypertrophic obstructive cardiomyopathy: a newly recognized anatomo-functional entity identified during recent alcohol septal ablation experience. Tex Heart Inst J. 2007;34(3):336-46.
14. Yoerger DM Picard MH Palacios IF Vlahakes GJ Lowry PA Fifer MA. Time course of pressure gradient response after first alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Am J Cardiol. 2006;97(10):1511-4.
15. Henein MY O'Sullivan CA Ramzy IS Sigwart U Gibson DG. Electromechanical left ventricular behavior after nonsurgical septal reduction in patients with hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol. 1999;34(4):1117-22.
16. van Dockum WG Kuijer JP Götte MJ Ten Cate FJ Ten Berg JM Beek AM et al. Septal ablation in hypertrophic obstructive cardiomyopathy improves systolic myocardial function in the lateral (free) wall: a follow-up study using CMR tissue tagging and 3D strain analysis. Eur Heart J. 2006;27(23):2833-9.
17. van Dockum WG Beek AM ten Cate FJ ten Berg JM Bondarenko O Götte MJ et al. Early onset and progression of left ventricular remodeling after alcohol septal ablation in hypertrophic obstructive cardiomyopathy. Circulation. 2005;111(19): 2503-8.
18. Mazur W Nagueh SF Lakkis NM Middleton KJ Killip D Roberts R et al. Regression of left ventricular hypertrophy after nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy. Circulation. 2001;103(11):1492-6.
19. Veselka J Prochazkova S Bolomova-Homolova I Duchonova R Tesar D. Effects of alcohol septal ablation for hypertrophic obstructive cardiomyopathy on Doppler Tei index: a midterm follow-up. Echocardiography. 2005;22(2):105-9.
20. Nagueh SF Lakkis NM Middleton KJ Killip D Zoghbi WA Quiñones MA et al. Changes in left ventricular diastolic function 6 months after nonsurgical septal reduction therapy for hypertrophic obstructive cardiomyopathy. Circulation. 1999;99(3):344-7.
21. El-Jack SS Nasif M Blake JW Dixon SR Grines CL O'Neill WW. Predictors of complete heart block after alcohol septal ablation for hypertrophic cardiomyopathy and the timing of pacemaker implantation. J Interv Cardiol. 2007;20(1):73-6.
22. Faber L Welge D Fassbender D Schmidt HK Horstkotte D Seggewiss H. Percutaneous septal ablation for symptomatic hypertrophic obstructive cardiomyopathy: managing the risk of procedure related AV conduction disturbances. Int J Cardiol. 2007;119(2):163-7.
23. Faber L Seggewiss H Welge D Fassbender D Ziemssen P Schmidt HK et al. Predicting the risk of atrioventricular conduction lesions after percutaneous septal ablation for obstructive hypertrophic cardiomyopathy. Z Kardiol. 2003;92(1):39-47.
25. Gietzen FH Leuner CJ Raute-Kreinsen U Dellmann A Hegselmann J Strunk-Mueller C et al. Acute and longterm results after transcoronary ablation of septal hypertrophy TASH). Catheter interventional treatment for hypertrophic obstructive cardiomyopathy. Eur Heart J. 1999;20(18):1342-54.
26. Kuhn H Seggewiss H Gietzen FH Boekstegers P Neuhaus L Seipel L. Catheter-based therapy for hypertrophic obstructive cardiomyopathy. First in-hospital outcome analysis of the German TASH Registry. Z Kardiol. 2004;93(1):23-31.
27. Hori Y Ueda M Nakayama T Saegusa N Uehara M Lee K et al. Occurrence of de novo sustained monomorphic ventricular tachycardia induced after percutaneous transluminal alcohol septal myocardial ablation for hypertrophic obstructive cardiomyopathy. Int J Cardiol. 2007;119(3):403-7.
28. Simon RD Crawford FA 3rd Spencer WH 3rd Gold MR. Sustained ventricular tachycardia following alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Pacing Clin Electrophysiol. 2005;28(12):1354-6.
29. Boltwood CM Jr. Chien W Ports T. Ventricular tachycardia complicating alcohol septal ablation. N Engl J Med. 2004;351(18):1914-5.
30. McGregor JB Rahman A Rosanio S Ware D Birnbaum Y Saeed M. Monomorphic ventricular tachycardia: a late complication of percutaneous alcohol septal ablation for hypertrophic cardiomyopathy. Am J Med Sci. 2004;328(3):185-8.
31. Alam M Dokainish H Lakkis N. Alcohol septal ablation for hypertrophic_obstructive cardiomyopathy: a systematic review of published studies. J Interv Cardiol. 2006;19(4):319-27.
32. van Dockum WG ten Cate FJ ten Berg JM Beek AM Twisk JW Vos J et al. Myocardial infarction after percutaneous transluminal septal myocardial ablation in hypertrophic obstructive cardiomyopathy: evaluation by contrast-enhanced magnetic resonance imaging. J Am Coll Cardiol. 2004;43(1):27-34.
33. Zeng Z Wang F Dou X Zhang S Pu J. Comparison of percutaneous transluminal septal myocardial ablation versus septal myectomy for the treatment of patients with hypertrophic obstructive cardiomyopathy--a meta analysis. Int J Cardiol. 2006;112(1):80- 4.
34. Fifer MA. Controversies in cardiovascular medicine. Most fully informed patients choose septal ablation over septal myectomy. Circulation. 2007;116(2):207-16.
35. Nagueh SF Buergler JM Quinones MA Spencer WH 3rd Lawrie GM. Outcome of surgical myectomy after unsuccessful alcohol septal ablation for the treatment of patients with hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol. 2007;50(8):795-8.
36. Ralph-Edwards A Woo A McCrindle BW Shapero JL Schwartz L Rakowski H et al. Hypertrophic obstructive cardiomyopathy: comparison of outcomes after myectomy or alcohol ablation adjusted by propensity score. J Thorac Cardiovasc Surg. 2005;129(2):351-8.
37. Nagueh SF Ommen SR Lakkis NM Killip D Zoghbi WA Schaff HV et al. Comparison of ethanol septal reduction therapy with surgical myectomy for the treatment of hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol. 2001;38(6):1701-6.
38. Firoozi S Elliott PM Sharma S Murday A Brecker SJ Hamid MS et al. Septal myotomymyectomy and transcoronary septal alcohol ablation in hypertrophic obstructive cardiomyopathy. A comparison of clinical haemodynamic and exercise outcomes. Eur Heart J. 2002;23(20):1617-24.