Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: how and when?

Alcohol septal ablation is a percutaneous alternative to surgical myotomy-myomectomy for symptomatic patients who have hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction. In the 11 years since its inception, the procedure has been proven safe and effective. While septal ablation may be more acceptable to patients than surgery, it lacks the long-term safety record of myotomy-myectomy. Here we discuss the mechanics of the procedure itself and examine its place in clinical practice, highlighting the importance of appropriate patient selection.