Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: the emerging role of the Cardiomyopathy Team

Alcohol septal ablation is a minimally invasive, safe, and effective procedure for the treatment of left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM) who remain symptomatic despite maximal medical therapy. Originally performed by Ulrich Sigwart in 1994, the procedure causes a iatrogenic infarction - through the injection of absolute alcohol - of the basal portion of the interventricular septum and aims at reducing LVOT obstruction in order to improve patient's hemodynamics and symptoms. Numerous studies have demonstrated the effectiveness and safety of the procedure, making it a valid alternative to surgical myectomy. The success of alcohol septal ablation depends upon the selection of the patient and the experience of both the operators and the center where the procedure is performed. In this review, we summarize current evidence on alcohol septal ablation, describe its procedural aspects and propose a multidisciplinary approach that involves a team of clinical cardiologists, interventionists, and cardiac surgeons, the Cardiomyopathy Team, with high experience in the clinical management of these patients.