Alcohol Septal Ablation

Alcohol septal ablation is a non-surgical procedure to treat hypertrophic cardiomyopathy. This is an inherited condition in which your heart muscle is abnormally thick. This procedure decreases symptoms and reduces future complications. Our primary reason for doing an ASA will be either preemptively associated with a significant increase in predicted neo-LVOT area before TMVR and may enable safe TMVR in patients usually prone to prohibitive risk of LVOT obstruction or emergently in the event of LVOT obstruction during TMVR or TAVR.

In the event of an LVOT obstruction we will put the patient on ECMO. Once the patient is "stable" we may proceed with ASA.

Equipment in the event of an emergency during TMVR:

• Priority pack
• 6F EBU 3.5 Guide
• OTW balloon (MD will tell you size after coronary angiogram)
• Sion Sion wire
• 98% Alcohol will be drawn up in a medallion syringe
• MD and tech will need new gloves after handling the alcohol

Warning: DO NOT SET MEDALLION SYRINGE DOWN ON TABLE, PLACE ON DESIGNATED TOWEL AWAY FROM ALL FLUIDS AND EQUIPMENT THAT MAY GO IN THE BODY!!!

Steps for procedure:

Guide advanced, LCA angiography performed. Septal chosen by MD, reference image on screen. OTW balloon and Sion wire advanced. Balloon inflated in septal and angiography performed to ensure occlusion of septal (NO CONTRAST SHOULD GO DOWN SEPTAL DURING ANGIOGRAPHY). Wire removed and medallion syringe attached to balloon to inject alcohol. Temp pacer is used as backup for heart block.

Prepare for possible temp/perm pacemaker.

Equipment needed for ASA not in the setting of emergency:

• Priority pack
• micro puncture
• 6F EBU 3.5 Guide (per MD's choice)
• OTW balloon (MD will tell you size after coronary angiogram)
• Runthrough wire
• 98% Alcohol will be drawn up in a medallion syringe
• Second small medallion syringe to flush balloon with hep saline (Get from IR neuro cart)
• MD and tech will need new gloves after handling the alcohol
• EITHER: 5Fr MP guide catheter for LV pressure measurement & 7Fr 90cm shuttle sheath or destination sheath
• OR: Langston (ASK DD)
• 2 2-ducer manifolds for simultaneous pressures
• Bipolar Pacing setup :
  • 5F Abbott Pacel Balloon-tip pacer
  • Dual Red/Black Pacing Remington cables
  • EP Quad Cable
  • 8Fr x 35 cm Brite Tip Sheath