Septal ablation

During a septal ablation procedure, cardiologists use an ethanol injection to reduce the size of heart muscle cells in patients who have a specific heart disorder known as hypertrophic obstructive cardiomyopathy. The goal of this experimental treatment is to decrease thickened muscle that divides the heart's two chambers so that it can retract, restoring normal blood flow. Hypertrophic obstructive cardiomyopathy can cause sudden death if the heart beats abnormally or if a patient becomes unconscious because blood is unable to exit the heart properly. With this disease, the septum of the heart slowly chokes off the blood supply to the body. As blood enters the left ventricle to be pumped out to all parts of the body and as the heart squeezes, the enlarged muscle gets in the way so blood cannot exit the heart by passing through the aortic valve into the aorta. That restriction causes an abnormal increase in pressure in the heart, which eventually can cause patients to have many different symptoms, including substantial shortness of breath, weakness, dizziness, chest pain, the inability to tolerate exercise, and sudden cardiac death. Hypertrophic obstructive cardiomyopathy frequently strikes young athletes and afflicts more than 500,000 Americans. Often the problem goes undetected for a long period of time and has no known cause.

Procedure

The septal ablation procedure begins with physicians inserting a small catheter into an artery in the groin, then threading it to the heart. Using X-rays and ultrasound to guide the way, they carefully inject pure alcohol into the vessel that nourishes the enlarged area, known as the septum. The alcohol is left in place for about five minutes. This induces a heart attack, causing the heart tissue to thin. The symptoms will almost magically disappear while the patients are still in the catheterization lab. The change is very dramatic. Over the next several days, weeks and months many patients continue to notice a marked improvement in their symptoms.

The UF Health difference

University of Florida cardiologists at the UF Health Cardiovascular Center were the first physicians in the Southeast to perform this procedure.. In the past, hypertrophic obstructive cardiomyopathy has been a very difficult condition to treat. Cardiologists have used medicines to relax the heart, helping to relieve the obstruction. Some physicians have resorted to implanting a pacemaker to change the way the heart contracts, helping to eject blood from the heart to the body. The only other alternative is open-heart surgery to cut away the overgrown muscle - a procedure that has mixed results and a longer recovery period. European physicians pioneered the novel ablation technique in the mid-1990s, and in 1996 William Spencer, M.D., a Baylor College of Medicine physician, pioneered this approach in the United States. UF researchers are studying the safety and effectiveness of this procedure in at least 500 patients. They are periodically examining study participants using ultrasound to monitor changes in the heart.

Multidisciplinary Team

Karen M. Smith, M.D.

UF College of Medicine assistant professor of Medicine, Division of Cardiology, director of the Gainesville VA Catheterization Cardiac Laboratory Karen Smith, M.D., is recognized for her expertise in the diagnosis and treatment of cardiovascular disease. Smith completed her residency in Internal Medicine and a fellowship in Cardiology and Interventional Cardiology at Wake Forest University Baptist Medical Center in Winston-Salem, N.C. She has been a UF faculty member with the UF HealthCardiovascular Center since 1998.