Hypertrophic Cardiomyopathy Ablation

• Written informed consent is taken.
• Patient is sedated.
• Catheter is passed from the groin vessels into the arteries that supply the heart, more specifically the septal part of the heart.
• Then 100% alcohol is carefully injected into the septal branch over a few minutes, taking precaution that it does not spill elsewhere in the heart arteries.
• Thereafter, the patient is monitored in the ICU and then discharged the next day.

The patient is shifted to the ICU to monitor the heart rhythm as the procedure can be prone for abnormal ECG tracing in the form of heart block or ventricular tachycardia. The patient is expected to lie flat for a few hours post procedure to prevent any complication at the groin site.

Also, an echocardiogram is done prior to discharge to assess the septal size, gradients across it and to rule out a ventricular septal defect (procedure induced). If no symptoms, the patient can be discharged a couple of days post procedure.

Follow-up and Monitoring

Long term follow-up is essential as these patients have to be regularly monitored annually or bi annually to adjust medicines and assess gradients and septal size on the echocardiogram.

Procedure is usually successful in more than ¾ of the cases. Post successful procedure, patients may experience considerable relief in symptoms with improvement in the quality of life.

Risks associated with the procedure are:

• Abnormal heart rhythm - ventricular tachycardia, can be treated with medicines or sometimes may need prolonged monitoring with ICU stay.
• Heart blocks can be seen post procedure, may need prolonged observation or may need permanent pacemaker insertion for the same.
• Chest pain may occasionally occur as the alcohol which is injected will cause damage and death to the heart muscles at that site. It can be life threatening if the alcohol gets spilled in the major arteries.
• Local site bleeding and swelling can occasionally occur due to injury to groin vessels.
• Very rarely a ventricular septal defect can be induced due to excessive thinning of the septum. It can be life threatening and may need device closure or urgent open heart surgery to repair the same.

Deciding open heart surgery v/s catheter directed alcohol ablation is paramount, as both procedures are associated with varied risks and benefits. Do consult your cardiologist for a detailed understanding of both the procedures to help you decide if they are necessary and if yes, which option will be better for you.