Authors

• Vesna Grubić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-6169-9386
• Lucija Šegović — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-6125-2979
• Iva Bušić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0002-8560-2267

Keywords

septal ablation, hypertrophic cardiomyopathy, nursing care

DOI

Full Text

Septal ablation (PTSMA) is a minimally invasive procedure used to treat hypertrophic obstructive cardiomyopathy (HOCM), a condition characterized by thickening of the heart muscle and obstruction of the left heart outflow tract. PTSMA reduces the thickness of the septum, improving blood flow and alleviating symptoms such as dyspnea, angina, and syncope. It is an invasive procedure during which a localized acute myocardial infarction (AMI) is intentionally induced in the septal area. (1-3) Patient preparation for septal ablation involves several important nursing interventions. Psychological preparation consists of explaining the entire procedure, potential complications during and after the intervention, and physical preparation (intravenous access, electrocardiogram - ECG, shaving of the groin area). Alcohol septal ablation is performed under local anesthesia. The procedure is preceded by the implantation of a temporary endovenous electrical stimulator due to the risk of conduction disturbances during and after the ablation procedure. The right femoral artery and right femoral vein are punctured for the introduction of the temporary pacemaker. The procedure involves the injection of a small amount of ethanol into the septal artery, resulting in a subsequent myocardial infarction in the targeted area of hypertrophic myocardium associated with obstruction. Immediately after the administration of ethanol, there is an instant akinesia of the targeted part of the septum, which facilitates blood flow and reduces the dynamic component of obstruction related to myocardial contractility. Post-septal ablation nursing care involves several aspects: monitoring (ECG, respiratory status, blood pressure, pulse), inspection of the arterial puncture site, and the site of the temporary pacemaker. The temporary pacemaker remains in place for up to 72 hours to ensure proper heart rhythm. Creatine kinase (CK) is measured daily for three days to monitor potential myocardial damage and assess heart function after the procedure. (1-3) Septal ablation is an important procedure for patients with HOCM, and nursing care plays a crucial role in ensuring optimal preparation, implementation, and post-interventional care, thereby reducing complications, facilitating hospital stay, and improving the patients’ quality of life.

Literature

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2. El Masry H, Breall JA. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Curr Cardiol Rev. 2008 August;4(3):193–7. https://doi.org/10.2174/157340308785160561
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