Francesco Pelliccia1, MD, PhD; Giampaolo Niccoli2, MD, PhD; Felice Gragnano3, MD; Giuseppe Limongelli4, MD, PhD; Elisabetta Moscarella3, MD; Giuseppe Andò5, MD, PhD; Augusto Esposito4, MD; Eugenio Stabile6, MD; Gian Paolo Ussia7, MD, PhD; Giuseppe Tarantini8, MD, PhD; Juan Ramon Gimeno9, MD, PhD; Perry Elliott10, MD, PhD; Paolo Calabrò3, MD, PhD; on behalf of the Working Group of Interventional Cardiology of the Italian Society of Cardiology
1. Department of Cardiovascular Sciences, Sapienza University, Rome, Italy; 2. Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy; 3. Division of Cardiology, A.O.R.N. “Sant'Anna e San Sebastiano”, Caserta, Italy; 4. Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; 5. Azienda Ospedaliera Policlinico “Gaetano Martino”, University of Messina, Messina, Italy; 6. Division of Cardiology, University of Naples Federico II, Naples, Italy; 7. Division of Cardiology, Tor Vergata University Policlinic, Rome, Italy; 8. Cardiology Unit, University of Padua Medical School, Padua, Italy; 9. Inherited Cardiac Diseases Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain; 10. Centre for Heart Muscle Disease, University College London, London, United Kingdom
Percutaneous alcohol septal ablation (ASA) is an effective and minimally invasive therapeutic strategy to resolve left ventricular outflow tract obstruction (LVOTO) in patients with hypertrophic cardiomyopathy who remain symptomatic on maximally tolerated medical therapy. First performed by Sigwart in 1994, the procedure consists in determining an iatrogenic infarction of the basal interventricular septum to reduce LVOTO and alleviate symptoms. Since its first description, numerous studies have demonstrated its efficacy and safety, proposing ASA as a valid and attractive alternative to surgical septal myectomy. The success rate of the intervention is profoundly affected by patient selection and centre experience. In this review, we sought to summarise current evidence on ASA, describing the procedure and proposing a cardiomyopathy team-based approach to resolve clinical disputes in clinical practice.