CPT® Code 93583

Percutaneous transcatheter septal reduction therapy (eg, alcohol septal ablation) including temporary pacemaker insertion when performed

Percutaneous transcatheter septal reduction therapy, commonly known as percutaneous transluminal septal myocardial ablation (PTSMA), is a minimally invasive procedure designed to alleviate dynamic left ventricular outflow tract (LVOT) obstruction, a condition often associated with hypertrophic obstructive cardiomyopathy (HOCM). This obstruction can lead to significant cardiac symptoms and complications, necessitating intervention. The procedure involves the use of a temporary pacemaker, which is inserted prior to the septal reduction to ensure proper heart rhythm during the intervention. The approach typically begins with an incision in the upper chest to access a vein, such as the cephalic, subclavian, or jugular vein, through which a sheath is introduced. This allows for the advancement of a pacemaker wire into the heart, where it is positioned appropriately. Following the pacemaker setup, the actual septal reduction is performed through the femoral artery, where a catheter is navigated into the coronary arteries to deliver alcohol to specific septal branches. This targeted delivery induces a controlled myocardial infarction, leading to necrosis of the obstructive septal tissue. As the tissue heals, scarring occurs, which ultimately reduces the obstruction at the LVOT and enhances left ventricular function. The procedure is carefully monitored using radiological guidance to ensure precision and effectiveness.