TASH Treatment: Specialists & Treatment Information

Treatment options in cardiology have improved significantly over the past few decades.

Patients with hypertrophic obstructive cardiomyopathy (HOCM) also benefit from these advances. This condition causes the heart muscle to become abnormally thickened. Patients then experience chest tightness and shortness of breath, both at rest and during physical exertion. The condition is incurable, but relief can be achieved with TASH treatment.

The basic principle behind TASH is to ablate the affected heart muscle using ethanol, i.e., high-dose alcohol. This procedure was first successfully used in 1995. Since then, open-heart surgery for hypertrophic obstructive cardiomyopathy has become virtually obsolete.

The ablation of the thickened heart muscle as part of TASH is performed during a cardiac catheterization procedure. The catheter is advanced into the coronary arteries. There, the doctor injects approximately 1 ml of alcohol into the affected area. This causes small vessels that the heart does not need to close off.

As a result, the thickened area is no longer supplied with blood, allowing blood flow in the heart to resume unimpeded.

The goal of TASH treatment is to restore the patient’s physical performance. Afterward, the patient should be able to perform daily activities at a moderate level of exertion.

The success of the treatment can be measured by a reduction or even complete elimination of symptoms. Such results are achieved in approximately 90 percent of patients who have undergone TASH treatment. As early as the first few days after treatment, many patients report a sense of relief and a reduction in shortness of breath.

TASH treatment may be used when medication has previously failed to produce results. Most patients with HOCM requiring treatment undergo this therapy. 

TASH treatment is not possible for all patients. Nor is it always successful. In such cases, heart surgery—known as a myectomy—is an alternative. It is also performed if there is additional damage to the heart.

Possible comorbidities include, for example,

• narrowed coronary arteries (coronary artery disease) or
• a diseased heart valve.

During a myectomy, the problematic thickened area of the heart muscle is removed via an open chest incision under general anesthesia. The ventricle is not opened during this procedure. Instead, the surgeon inserts the cutting instrument through the heart valve into the ventricle to remove the thickened heart muscle. The risk to the patient is higher with a myectomy than with TASH treatment.

The problematic thickening of the heart muscle is located in a sensitive area of the heart. This is where the conduction pathways for the electrical stimulation of the heart muscle cells—which cause the heart to beat—run. Therefore, TASH treatment can lead to dysfunction of these pathways. This will result in a lack of a heartbeat or, at the very least, a permanently significantly slowed heartbeat.

As a precaution, the patient is therefore often fitted with a temporary pacemaker for a few hours immediately after the procedure. In rare cases, a permanent pacemaker must be implanted afterward. 

Like a myectomy, TASH treatment is performed only by experienced cardiac surgeons in highly specialized cardiac centers. Both treatment methods are considered very effective in alleviating and completely eliminating symptoms associated with HOCM.

Rehabilitation is usually not necessary following TASH treatment. The procedure is minimally invasive. After being discharged from the hospital, the patient should take it easy for a while. A period of about two weeks is usually recommended.

After that, the patient may engage in physical activity to the extent that their well-being allows.

Athletes who have trained at a competitive level, in particular, must take it easy, even if they feel perfectly healthy.

However, there is no reason to avoid regular physical activity. In fact, doctors explicitly recommend that patients get enough exercise after TASH treatment. Exercise has a positive effect on cardiovascular regulation, which also reduces the risk of a heart attack.

Activities such as

• swimming,
• cycling, and
• hiking,

that is, sports involving fluid movements.

After successful TASH treatment, many patients can significantly reduce the number of medications they need. Many patients can even stop taking certain medications, such as beta-blockers, altogether.

Patients with hypertrophic obstructive cardiomyopathy already suffer from reduced heart function. Therefore, they should minimize all risk factors that could lead to further heart disease. This requires, for example, a balanced and healthy diet, as well as avoiding cigarettes and excessive stress.

Both TASH treatment and open-heart surgery are effective in the long term. Patients with HOCM experience significant relief from their symptoms through TASH treatment. This allows the typical symptoms of the disease to be permanently reduced or completely eliminated.

Furthermore, TASH treatment can help prevent serious cardiac arrhythmias. There is also evidence that TASH treatment has a positive impact on life expectancy in patients with severe HOCM.