Patient selection for alcohol septal ablation for hypertrophic obstructive cardiomyopathy: clinical and echocardiographic evaluation

It has been 18 years since the first alcohol septal ablation was performed in London for relief of symptoms associated with left ventricular outflow tract obstruction in hypertrophic obstructive cardiomyopathy. In the interval since the introduction of this catheter-based alternative to surgical myectomy, use of this procedure has disseminated across the globe, and numerous reports have been published describing its efficacy and safety when performed at high-volume centers by skilled operators. Retrospective comparisons of alcohol septal ablation with surgical myectomy have not conclusively demonstrated superiority of either procedure. The current treatment approach relies on clinical judgment and patient preference. Optimal results of alcohol septal ablation depend on careful patient selection based on clinical and echocardiographic criteria.