Name of the Procedure:

Percutaneous Transcatheter Septal Reduction Therapy (common name: Alcohol Septal Ablation) including Temporary Pacemaker Insertion

Summary

Percutaneous transcatheter septal reduction therapy, commonly known as alcohol septal ablation, is a minimally invasive procedure used to treat hypertrophic cardiomyopathy. This condition results in the thickening of the heart muscle, particularly the septum, which can obstruct blood flow. Alcohol is injected into the septal artery to induce a controlled heart muscle shrinkage, relieving the obstruction. A temporary pacemaker may also be inserted during the procedure to manage potential heart rhythm disturbances.

Purpose

This procedure aims to alleviate symptoms caused by hypertrophic cardiomyopathy, such as shortness of breath, chest pain, and fainting. The expected outcome is reduced heart muscle thickness, improved blood flow, and an overall enhancement in the patient’s quality of life.

Indications

• Severe symptoms of hypertrophic cardiomyopathy unresponsive to medication.
• Obstruction of blood flow due to thickened heart muscle.
• Patients with recurrent episodes of fainting or arrhythmias associated with hypertrophic cardiomyopathy.

Preparation

• Patients may be required to fast for at least 6-8 hours before the procedure.
• Medication adjustments, especially blood thinners, may be necessary as per the doctor’s instructions.
• Diagnostic tests such as echocardiography, electrocardiogram (ECG), and possibly cardiac MRI will be performed to assess the condition of the heart and plan the procedure.

Procedure Description

1. The patient is positioned, usually under local anesthesia and sedative medications.
2. A catheter is inserted through a small incision in the groin and guided to the heart.
3. Once positioned, contrast dye is used to identify the septal artery supplying the thickened heart muscle.
4. A small amount of alcohol is injected into the artery, causing the targeted heart muscle to shrink.
5. A temporary pacemaker is inserted, if needed, to manage any arrhythmias that may occur during the procedure.
6. The catheter and pacemaker are eventually removed after ensuring the patient’s heart rhythm is stable.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Performed in a hospital’s cardiac catheterization lab or cardiovascular operating room.

Personnel

• Interventional cardiologist.
• Cardiac nurses.
• Anesthesiologist or sedation specialist.
• Technicians specialized in catheterization procedures.

Risks and Complications

• Temporary or permanent heart rhythm disturbances.
• Blood vessel damage or bleeding.
• Infection at the catheter insertion site.
• In rare cases, severe complications like heart attack or stroke.

Benefits

• Significant reduction in heart muscle obstruction.
• Symptom relief, including improved breathing and reduced chest pain.
• Improved quality of life and physical activity tolerance.
• Patients may notice improvements within a few days to weeks after the procedure.

Recovery

• Patients typically stay in the hospital for 1-2 days for monitoring.
• Post-procedure instructions include avoiding strenuous activities for a few days.
• Follow-up appointments to monitor heart function and rhythm.
• Any medications such as blood thinners will be adjusted as needed.

Alternatives

• Medications to manage symptoms, though they may be less effective for severe cases.
• Surgical myectomy, which involves removing part of the thickened heart muscle. This is more invasive and involves a longer recovery period.
• Implantable cardiac devices (e.g., ICDs) to manage rhythm disturbances.

Patient Experience

During the procedure, patients may feel mild discomfort or pressure at the insertion site. Post-procedure, some soreness and bruising at the insertion site are common. Pain management includes prescribed medications and comfort measures like applying ice to the insertion site. Most patients experience significant symptom relief shortly after the procedure with gradual improvement over time.