Alcohol septal ablation (ASA) is an effective interventional therapeutic strategy to reduce or eliminate left ventricular outflow tract obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM). Although ASA was introduced 25 years ago, there are still no available guidelines to follow. Therefore, most interventional cardiologists rely on their own experience, which is often limited by a relatively low number of performed procedures. This paper presents ten tips and tricks to safe and effective ASA for HOCM.

Department of Cardiology Charles University University Hospital Motol 2nd Medical School Prague 15000 Czech Republic

See more in PubMed

Veselka J, Faber L, Liebregts M. Short- and long-term outcomes of alcohol septal ablation for hypertrophic obstructive cardiomyopathy in patients with mild left ventricular hypertrophy: a propensity score matching analysis. Eur Heart J. 2019;40(21):1681–1687. PubMed

Elliott P M, Anastasakis A, Borger M A. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy. Eur Heart J. 2014;35(39):2733–2779. PubMed

Gersh B J, Maron B J, Bonow R O. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy. Circulation. 2011;124(24):e783–e831. PubMed

Veselka J, Lawrenz T, Stellbrink C. Early outcomes of alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a European multicenter and multinational study. Catheter Cardiovasc Interv. 2014;84(01):101–107. PubMed

Veselka J, Faber L, Jensen M K. Effects of institutional experience on outcomes of alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Can J Cardiol. 2018;34(01):16–22. PubMed

Veselka J, Tomašov P, Januška J, Krejčí J, Adlová R. Obstruction after alcohol septal ablation is associated with cardiovascular mortality events. Heart. 2016;102(22):1793–1796. PubMed

Veselka J, Jensen M, Liebregts M. Alcohol septal ablation in patients with severe hypertrophy. Heart. 2020;106:462–466. PubMed

Veselka J, Jensen M K, Liebregts M. Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy: results from the Euro-ASA registry. Eur Heart J. 2016;37(19):1517–1523. PubMed

Cooper R M, Binukrishnan S R, Shahzad A, Hasleton J, Sigwart U, Stables R H. Computed tomography angiography planning identifies the target vessel for optimum infarct location and improves clinical outcome in alcohol septal ablation for hypertrophic obstructive cardiomyopathy. EuroIntervention. 2017;12(18):e2194–e2203. PubMed

Spacek M, Zemanek D, Tomasov P, Veselka J. Early opening of dormant septal collaterals during alcohol septal ablation: a possible hazard of remote necrosis. Can J Cardiol. 2013;29(11):1.531E8–1.531E10. PubMed

Veselka J, Krejčí J, Tomašov P. Outcome of patients after alcohol septal ablation with permanent pacemaker implanted for periprocedural complete heart block. Int J Cardiol. 2014;171(02):e37–e38. PubMed

Veselka J, Duchonová R, Procházková S, Pálenícková J, Sorajja P, Tesař D. Effects of varying ethanol dosing in percutaneous septal ablation for obstructive hypertrophic cardiomyopathy on early hemodynamic changes. Am J Cardiol. 2005;95(05):675–678. PubMed

Veselka J. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: a review of the literature. Med Sci Monit. 2007;13(04):RA62–RA68. PubMed