skip to main content

ASA Procedural Risks — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCardiomyopathyASA Procedural RisksEECC

A 50-year-old woman with HCM and recurrent syncope despite bisoprolol has an LVOT resting gradient of 80 mmHg. She declines surgical myectomy. Her cardiologist discusses cardiac septal perforator embolisation (alcohol septal ablation). What is the main risk?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Complete heart block requiring permanent pacemaker occurs in 5-15% of patients; other risks include MI of the target territory, VSD, and coronary artery dissection from catheter manipulation

Alcohol septal ablation (ASA) involves selective injection of ethanol into a septal perforator artery supplying the hypertrophied basal septum, creating a controlled MI that reduces septal thickness and LVOT obstruction. The most important complication is complete heart block (5-15%), which may be transient or require permanent pacemaker implantation. This risk is higher than with surgical myectomy (~2-5%). Other complications include: procedural MI (expected — targeted), VSD (rare), coronary artery dissection (from septal perforator catheterisation), and tamponade (rare). Contrast echocardiography during the procedure confirms the target territory before ethanol injection. The 2023 ESC Cardiomyopathy Guidelines recommend ASA as a Class IIa alternative to myectomy when surgery is declined or high-risk, performed at experienced centres.

Reference: ESC (2023): Cardiomyopathies Guidelines