Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy: A Contemporary Perspective
Felice Gragnano, Francesco Pelliccia, Natale Guarnaccia, Giampaolo Niccoli, Salvatore De Rosa, Raffaele Piccolo, Elisabetta Moscarella, Enrico Fabris, Rocco Antonio Montone, Arturo Cesaro, Italo Porto, Ciro Indolfi, Gianfranco Sinagra, Pasquale Perrone Filardi, Giuseppe Andò, Paolo Calabrò
Abstract
Alcohol septal ablation is a minimally invasive procedure for the treatment of left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM) who remain symptomatic despite optimal medical therapy. The procedure causes a controlled myocardial infarction of the basal portion of the interventricular septum by the injection of absolute alcohol with the aim of reducing LVOT obstruction and improving the patient's hemodynamics and symptoms. Numerous observations have demonstrated the efficacy and safety of the procedure, making it a valid alternative to surgical myectomy. In particular, the success of alcohol septal ablation depends on appropriate patient selection and the experience of the institution where the procedure is performed. In this review, we summarize the current evidence on alcohol septal ablation and highlight the importance of a multidisciplinary approach involving a team of clinical and interventional cardiologists and cardiac surgeons with high expertise in the management of HOCM patients-the Cardiomyopathy Team.