Novel Techniques for Alcohol Septal Ablation in Hypertrophic Obstructive Cardiomyopathy With Complex Anatomy: A Case Series

Alcohol septal ablation (ASA) is an established treatment for hypertrophic obstructive cardiomyopathy (HOCM). However, conventional techniques may be challenging in cases with complex septal branch anatomy, including hairpin curves, extremely small branches, and acute angle bifurcations. We present three innovative catheter techniques that expand the applicability of ASA in these challenging anatomical scenarios. The double balloon technique overcomes hairpin curves in the proximal septal branches, while the perfusion balloon and microcatheter technique enables ablation of extremely small branches. The balloon screen technique facilitates access to small branches at acute angles. These methods were successfully applied to three patients with medically refractory HOCM, resulting in a significant reduction in left ventricular outflow tract pressure gradients and an improvement in symptoms. These novel techniques provide potential solutions for anatomically challenging cases, expanding the indications for ASA and improving clinical outcomes for patients with HOCM.