Interventricular Septal Alcohol Ablation for HOCM at Cooper

Cooper cardiologists recently performed the first alcohol ablation of the interventricular septum in the South Jersey region, providing a new treatment option for symptomatic hypertrophic obstructive cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is the most common genetically transmitted cardiovascular disease. Also known as Idiopathic Hypertrophic Sub-aortic Stenosis (IHSS), HCM accounts for less than 5% of the overall heart failure population. Unlike dilated cardiomyopathy, HCM is distinguished by a thickening and stiffening of the interventricular septum. A subset of this population, 25-50%, also involves obstruc- tion of the left ventricular outflow tract and is labeled as hypertrophic obstructive cardiomyopathy(HOCM).

HOCM is characterized by symptoms exacerbated with exertion: angina, palpitations, dyspnea, syncope, and sudden death. Most patients manifest a systolic murmur. In addition, arrhythmias are often present and can be both atrial and ventricular in origin.

Treatment Options

Until recently, treatment options for HOCM patients were limited to medical management, dual chamber pacing, or surgical myectomy. Beta blockers and calcium channel blockers are the primary pharmacologic tool, with many patients demonstrating symptom improvement initially. However, a significant number either do not respond to drug therapy, or develop intolerance. In additional, dual chamber pacing has achieved some success in HOCM patients, though less than half have sustained long-term symptom relief.

Surgical myectomy, which involves debulking of the ventricular septum and enlargement of the left ventricular outflow tract, has demonstrated long-term symptom relief in many HOCM cases. However, as many patients are not surgical candidates either due to contraindications or preference, clinicians are now pursuing interventional treatment options.

New Interventional Therapy

Alcohol ablation of the interventricular septum is a catheter-based treatment that involves direct injection of ethyl alcohol into a targeted region of the septal wall. “Identification of an appropriate branch supplying the hypertrophied septal region is crucial to the success of this procedure,” says Phillip Koren, M.D., the Cooper interventional cardiologist who performed the recent procedure. Echocardiography with a doppler study of the outflow tract are the primary tools in the diagnostic work-up of these patients.

“The procedure result is a targeted septal myocardial infarct that decreases the obstruction in the outflow tract, and precipitates a remodeling process that gradually shrinks the septum and widens the tract,” says Dr. Koren. “Substantial symptom relief can often be seen in a matter of days,” he adds.

Post-Procedure Concerns

Arrhythmia management is a primary post-procedure concern for this population. Right bundle branch block and complete heart block have been reported in the literature, with permanent pacemaker implantation an elective or emergent consideration in some cases.

“Alcohol ablation offers the potential for significant improvement in quality of life for a patient population with limited treatment options,” says Dr. Koren. “ Our patient has experienced tremendous symptom relief since the procedure was performed.”

For more information about interventricular septal alcohol ablation or interventional services at Cooper, please call: (856) 976-PUMP (7867).