Alcohol septal ablation is a nonsurgical procedure to treat hypertrophic cardiomyopathy. This is an inherited condition in which your heart muscle is abnormally thick. The procedure helps relieve your symptoms. It also reduces future complications.

Your left and right ventricles are the two lower chambers of your heart. A muscular wall called the septum separates the two ventricles. In hypertrophic cardiomyopathy, the walls of your ventricles and septum have thickened abnormally. The septum bulges into your left ventricle and partially blocks the blood flow out to your body. This places extra pressure on your heart. Fatigue and shortness of breath may result.

Alcohol septal ablation uses a thin, flexible tube called a catheter. It has a balloon at the tip. Your doctor threads the tube through a blood vessel in your groin. It goes all the way to the artery that carries blood to your septum. Your doctor then injects alcohol through the tube into the area where the heart is too thick. The alcohol is toxic and causes some of your heart muscle cells to shrink and die. The scar tissue that remains is thinner than the thickened heart muscle was before. Blood is able to get past the thinned muscle and through the aortic heart valve. This improves blood flow through your heart and out to your body. Your doctor then deflates the balloon and guides the tube back out of your body.

For many people with hypertrophic cardiomyopathy, medicines are enough to treat their condition. But some people with severe symptoms don't respond well to medicine. They may get help from alcohol septal ablation. This procedure usually works very well to reduce symptoms. It may prevent the need for cardiac surgery. If you plan to get pregnant, you may need alcohol septal ablation before getting pregnant, even if your symptoms aren't severe.

Septal myectomy is another option for those considering alcohol septal ablation. Both procedures decrease the thickness of the septum. In septal myectomy, a surgeon removes extra muscle from the thickened septum. Because septal myectomy is a type of open heart surgery, it takes longer to recover. But both alcohol septal ablation and septal myectomy may increase the need for a pacemaker.

Some people can have either septal myectomy or alcohol septal ablation. Others might do better with one or the other. Talk with your doctor about the risks and benefits of each technique. Alcohol septal ablation is often preferred in older people and those whose thickening is not too severe. Some medical conditions may increase the risk of open heart surgery. In that case, alcohol septal ablation may be a better option for you. If you have other heart abnormalities to repair, you may have septal myectomy instead.

Most people who have alcohol septal ablation have a successful outcome. There are possible risks, though. Your risks will partly depend on your medical history. Talk with your doctor about any concerns you have.

The risks include:

• Abnormal heart rhythms (fast or slow).
• Heart block that requires a pacemaker.
• Bleeding at the site where your doctor inserts the catheter.
• Infection.
• Blood clots.
• Abnormal fluid buildup around your heart.
• Coronary artery complications.
• Shock.
• Failure of the procedure to work effectively.

Heart block is one of the most common complications. Heart block is a disruption of the electrical signals through your heart. It can cause a slow heart rate. Certain kinds of heart block require treatment with a permanent pacemaker. If bleeding around the heart occurs, you may need open heart surgery.

You are at greater risk for complications if you are older or if you have other heart problems. Hospitals and doctors who specialize in alcohol septal ablations have the lowest rates of complications.

Talk with your doctor about how to prepare for your procedure. Work with them to find an experienced medical center and doctor to do it. Follow any directions you are given for not eating or drinking beforehand.

You may have these tests before your alcohol septal ablation:

• Chest X-ray
• Blood tests
• Echocardiogram
• Electrocardiogram (ECG)
• Cardiac MRI

These tests will help your doctor know what your heart looks like. Testing may find other potential conditions that can affect the procedure.

Tell your health care team about your health history. Also tell them about all medicines you take, including over-the-counter medicines, herbal medicines, and supplements. You may need to stop taking certain medicines before the procedure, such as beta-blockers. Tell your doctor if you think you are pregnant or if you are breastfeeding. Tell your health care team about any allergies you have. These include allergies to contrast dye, skin preparations, and anesthesia or sedatives.

Talk with your doctor about what to expect during your procedure. It may take 1 to 2 hours or more. It's usually done in a cardiac catheterization lab. A heart specialist and a special team of nurses and technicians will do the ablation. During the procedure:

• The team may give you medicine that helps you relax.
• The team may give you aspirin and heparin (a common blood thinner) before the procedure. This will help reduce the likelihood of blood clots.
• The groin area where the catheter will be inserted may need to be shaved. Then a local anesthetic (numbing medicine) is applied to your skin. A small incision is made.
• Your doctor will insert a small, flexible tube (catheter) into an artery or vein in your groin.
• The doctor will thread the tube through your blood vessels all the way to your heart.
• Your doctor may use angiography, along with a special type of echocardiogram to make sure the catheter is in the right place.
• A small amount of pure alcohol is released into an artery in your septum. This destroys part of the septum muscle. It may feel uncomfortable.
• Your doctor will take measurements of the pressure in your heart to ensure it has improved.
• The team will remove the tubes from your groin.
• The team will close and bandage the site where they inserted the tubes.

Talk with your doctor about what you need to do after the alcohol septal ablation.

In the hospital after the procedure:

• You'll spend several hours in a recovery room.
• The team will watch your vital signs. They'll check your heart rate and breathing.
• The team may do an echocardiogram after the procedure to look at your septum and left ventricle. This will show your doctor how successful the ablation was.
• You'll need to lie flat for several hours after the procedure. Don't bend your legs. This will help prevent bleeding.
• Your doctor might prescribe medicines that keep your blood from clotting (anticoagulants).
• You may get pain medicine if you need it.
• If you have a heart rhythm problem called heart block, you may need a permanent pacemaker.
• You can expect to spend about 2 to 3 days or more in the hospital. The time can vary.

At home after the procedure:

• Talk with your doctor about continuing your normal medicines.
• Discuss when it's OK to start exercising again.
• You will probably be able to return to light activity fairly soon.

Most people who have this procedure see their symptoms improve quickly. Your symptoms may continue for a while after the procedure.

After you leave the hospital, it's important to follow all the instructions your doctor gives you for medicines, exercise, diet, and wound care. Keep all your follow-up appointments.

Before you agree to the test or the procedure, find out:

• The name of the test or procedure.
• The reason you are having the test or procedure.
• What results to expect and what they mean.
• The risks and benefits of the test or procedure.
• The possible side effects or complications.
• When and where you are to have the test or procedure.
• Who will do the test or procedure and what that person's qualifications are.
• What would happen if you did not have the test or procedure.
• Any alternative tests or procedures to think about.
• When and how you will get the results.
• Who to call after the test or procedure if you have questions or problems.
• How much you will have to pay for the test or procedure.