Golden jubilee of hypertrophic cardiomyopathy: is alcohol septal ablation the gold standard?

In the golden jubilee year of the first recognition of hypertrophic obstructive cardiomyopathy, we are discussing the intricacies and impact of alcohol septal ablation (ASA) in the treatment of this clinical entity. Since its first revelation 14 years ago, ASA has become a well-established treatment modality for symptomatic hypertrophic obstructive cardiomyopathy patients. With better recognition of the implication of first septal branch and right dose of alcohol to be used for ablation, the incidence of complications like complete heart block are coming down along with better procedural success rates. In appropriately selected patients and in expert hands ASA has produced excellent results. Surgical myectomy, even though it has produced excellent results, is available only at a few centers and patient preference is tilted more for a less invasive procedure like ASA. This has contributed towards far more ASAs being performed worldwide than surgical myectomies. While more than 5000 ASAs have been performed in the last 14 years, the number of patients who have had myectomy remains around 3000–4000. The pendulum of gold standard may have started swinging away from surgical myectomy towards ASA.