Alcohol septal ablation in hypertrophic cardiomyopathy: For which patients?

Percutaneous and surgical therapies for septal reduction for hypertrophic cardiomyopathy have been going head-to-head for the past 20 years with similar outcomes and mortality rates, although contemporary myectomy seems to materialize its superiority. However, on closer analysis, the external validity of studies advocating myectomy does not translate to all centres. The aim of this review was to examine the most recent data on septal reduction therapy and to attempt to phenotype the appropriate patient for each of the two treatments. The key to similar low mortality rates between ventricular septal myectomy and alcohol septal ablation appears to be proper patient selection performed in high volume clinical environments. Furthermore, we analyse the role of mavacampten (the recently approved cardiac myosin inhibitor) in replacing or complementing the two septal reduction therapies.

Automated summary

Percutaneous and surgical therapies for septal reduction for hypertrophic cardiomyopathy have similar outcomes and mortality rates, but myectomy seems to have superiority in certain cases. However, the external validity of studies endorsing myectomy is not universal. This review aims to examine recent data on septal reduction therapy and phenotyping of patients for each treatment, and discusses the potential role of mavacampten as an alternative or complement to these therapies.