Alcohol septal ablation for hypertrophic cardiomyopathy: indications and technique

Alcohol septal ablation for the treatment of hypertrophic cardiomyopathy has been the subject of great interest, and the number of procedures performed is increasing despite an absence of randomized trial data. Although straightforward in concept, alcohol septal ablation may be considerably more difficult in actual practice. To optimize the results and prevent complications, the anatomy of the septal arcade architecture must be understood and the anatomic relationship between the septal artery and the specific portion of the septum to be ablated must be carefully delineated. For the latter, during the procedure, an echocardiographic contrast medium injection into the septal artery of interest is essential. Selection of the volume and amount of alcohol to be injected varies depending on the size and distribution of the septal artery. Specific complications such as conduction defects, hemodynamic compromise, ventricular arrhythmias, and inadequate gradient reduction can be minimized by specific technical approaches. After ablation, protocols are needed for periprocedural guidelines because some complications may occur late during the next several days. For optimal results, patients need to be selected after catheter assessment and combined echocardiography and angiography, and ablation techniques need to be scientific and rigorous.