Treatment for Hypertrophic Obstructive Cardiomyopathy

Posted by William on June 8, 2011

Q.I heard about a treatment for hypertrophic obstructive cardiomyopathy that involves injecting alcohol into the heart. Does it work? What are the risks?

A. In this uncommon type of cardiomyopathy (a disease of the heart muscle), the wall (septum) between the ventricles thickens, and pressure builds up in the left ventricle, the heart’s main pumping chamber. Caused by an inherited genetic defect, hypertrophic obstructive cardiomyopathy (HOCM) is diagnosed with echocardiography, an ultrasound test of the heart.

Beta blockers or calcium channel blockers can often relieve the symptoms, which include angina, congestive heart failure, and fainting spells. Otherwise, a surgeon can cut out the upper portion of the enlarged septum. Though often successful, this open-heart operation is risky in elderly patients.

In rare cases, people who undergo the procedure must use a pacemaker for the rest of their lives. With the newer alcohol ablation technique, a surgeon uses a catheter to inject ethyl alcohol into the arteries that supply the septum. The alcohol blocks off those arteries, inducing a small, controlled heart attack that damages the excess tissue, thinning the septum.

So far, the small number of patients who’ve had the procedure have experienced significant relief. But up to a third of them have needed a permanent pacemaker, and no long-term results are yet available. For now, alcohol ablation is still considered a last resort, reserved for people who are seriously disabled by HOCM.