Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy

Treatment of obstructive hypertrophic cardiomyopathy remains challenging. Medical therapy, surgical therapy, and pacemaker therapy have been shown to be beneficial in some patients over the years. Alcohol septal ablation is a catheter-based intervention that causes a controlled infarct in the septum leading to a decrease in the left ventricular outflow tract obstruction. Along with the impressive reductions in left ventricular outflow tract gradient, there is subjective and objective improvement in symptoms. Development of complete heart block requiring a permanent pacemaker after alcohol septal ablation remains a frequent complication, but has decreased in some recent studies. Alcohol septal ablation has been shown to improve diastolic function, decrease mitral regurgitation, decrease left ventricular hypertrophy and mass, as well as cause changes at the cellular and molecular level that improve myocardial function. Comparison of alcohol septal ablation to surgical myectomy has shown favorable results. Long-term follow-up of alcohol septal ablation has shown sustained results out to several years.