The role of alcohol septal ablation in the treatment of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy.

More than 50 years after its first modern pathologic description, hypertrophic cardiomyopathy (HCM) continues to excite controversy in the medical literature. One of the most polarizing issues in this field has been the treatment of symptomatic left ventricular outflow tract obstruction, a common feature of the disease that causes limiting symptoms and increases the risk of heart failure, atrial fibrillation, and cardiovascular death (1,2). In this issue of the Journal, agueh et al. (3) report data from a North American egistry of 800 symptomatic patients treated with alcohol eptal ablation. The results are broadly consistent with ecent meta-analyses in which alcohol septal ablation was ssociated with mortality rates and improvements in funcional status similar to those reported for surgical treatment, lbeit with a higher risk of permanent pacemaker implanation and greater post-intervention outflow tract gradient 4–6). The question remains, do the 2 techniques have quivalent safety and efficacy?