Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy: A Contemporary Reappraisal

Percutaneous alcohol septal ablation (ASA) is an effective and minimally invasive therapeutic strategy to resolve left ventricular outflow tract obstruction (LVOTO) in patients with hypertrophic cardiomy-opathy who remain symptomatic on maximally tolerated medical therapy. Firstly performed by Sig-wart in 1994, the procedure consists in determining an iatrogenic infarction of basal interventricular septum to reduce LVOTO and alleviate symptoms. Since its first description, numerous studies demonstrated its efficacy and safety, proposing ASA as a valid and attractive alternative to surgical septal myectomy. The success rate of the intervention is profoundly impacted by patient selection and center experience. In this review we sought to summarize current evidence on ASA, describing the procedure and proposing a cardiomyopathy team-based approach to resolve clinical disputes in clinical practice.