Alcohol septal ablation (ASA) is a procedure that can help improve your heart health and ease the symptoms of obstructive hypertrophic cardiomyopathy (oHCM). Symptoms of oHCM can affect your daily life and lead to life-threatening complications.

Here’s what to know about ASA — who can get it, how it’s done, and the risks.

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Who Is Alcohol Septal Ablation Recommended For?

People with mild oHCM can manage the condition with medications like beta-blockers, calcium channel blockers, and cardiac myosin inhibitors. However, if symptoms are severe, other treatments may be needed, such as ASA.

ASA is one option for nonmedication treatment of oHCM. In another procedure, septal myectomy, a surgeon opens up the heart and removes the excess heart tissue blocking blood flow. This procedure is more invasive than ASA.

ASA is often recommended for older people because it’s a minimally invasive procedure. It’s also helpful for people with less septal thickening.

Preparing for Alcohol Septal Ablation

Just like with many invasive procedures, you’ll need to stop eating and drinking the night before your ASA. You may also need to stop taking some oHCM medications, such as beta-blockers.

Don’t stop medication on your own. Talk to your doctor about which medications you should take prior to your procedure.

Your cardiologist may order blood tests before the procedure. They may also order cardiac tests, including:

• Angiography (a type of X-ray imaging with contrast), to see the blood vessels of the heart, exact structure of the heart, and where the excess tissue is
• An electrocardiogram (EKG), which tracks the heart’s electrical activity
• An echocardiogram, an ultrasound test that can show the heart’s pumping ability and structure

What Happens During Alcohol Septal Ablation

You will be awake during ASA, but your healthcare team may give you medications to help you relax. They may also give you medications like aspirin or heparin to thin your blood and prevent blood clots.

To start the procedure, your team will apply a local anesthetic to your wrist or groin. (Your groin may need to be shaved before the procedure). After the area is numb from the anesthetic, a small incision is made.

Your cardiologist will insert a tiny, flexible tube called a catheter into the incision. This tube is placed into a blood vessel. The cardiologist then uses angiography to navigate the catheter through the blood vessels and into the heart.

When the catheter is properly placed by the excess heart tissue, isopropyl alcohol is injected into the catheter. This alcohol destroys the excess tissue. This part of the procedure may feel uncomfortable.

Once this is complete, the catheter is removed and the incision closed with stitches and a bandage. You will receive a temporary pacemaker for a few days to make sure that your heart rhythm is properly functioning.

Recovering From Alcohol Septal Ablation

Once the procedure is complete, you will stay in the hospital for your recovery. You will likely stay in the hospital for 48 to 72 hours. If a catheter was inserted through your groin, you will need to lie on your back with your legs straight for several hours. This prevents the incision from bleeding.

Your healthcare providers will monitor your heart rhythm and may perform an echocardiogram of your heart to see how well the alcohol affected the extra septal tissue.

Recovery time after ASA varies. Talk with your healthcare provider to find out when it’s safe to go back to work and exercise. Many people can return to their daily activities within a week.

Many people with HCM find that they experience symptom relief immediately after ASA. Some people notice HCM symptoms improve within six months after the procedure, as the heart tissue recovers.

Risks and Complications of Alcohol Septal Ablation

Most people who go through an alcohol septal ablation have a successful outcome. However, there are risks. These include:

• Blood clots
• Coronary artery injury
• Infection at the incision area
• Heart damage
• Fluid buildup around the heart (pericardial effusion)

One of the more common complications of ASA is a condition called heart block. This happens when the heartbeat becomes too fast or too slow (arrhythmias).

Heart block is treated with the placement of a permanent pacemaker, which keeps your heart beating correctly.

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Have you had an alcohol septal ablation? If so, what was your experience like? Let others know in the comments below.