Looking Back at 30 Years of Alcohol Septal Ablation and Looking Forward to the Future

In the 30 years since Dr Sigwart's first pioneering procedures, alcohol septal ablation (ASA) has become the standard catheterisation procedure to reduce or eliminate obstruction in the left ventricular outflow tract. This procedure reduces the pressure gradient by 70%-80%, and only 10%-20% of patients have a residual gradient > 30 mm Hg after ASA. The mortality rate of the procedure is < 1%, and ∼ 10% of patients require permanent pacemaker implantation for higher degrees of atrioventricular block. Given the potential risks, ASA should be performed only in centres with extensive experience in the treatment of hypertrophic cardiomyopathy and with comprehensive therapeutic options, including myectomy. In the future, ASA is likely to be increasingly complemented by catheter-based mitral valve repair, which will increase its efficacy.