Selection of Septal Ablation vs Septal Myectomy

Septal AblationSeptal Myectomy
Patient preference: less invasive, shorter recoveryPatient preference: most effective, longest follow-up
Expertise widely availableExpertise limited to few HCM centers
Increased risk PPM with normal QRS and LBBBIncreased risk PPM with RBBB
Multiple comorbidities at high surgical riskAddress other problems: fixed subvalvular obstruction, primary mitral valve disease, aortic disease, atrial arrhythmias, multivessel CAD, and mid and apical hypertrophy
Mild hypertrophy, elderly patientsMassive hypertrophy, younger patients
  • CAD indicates coronary artery disease; HCM, hypertrophic cardiomyopathy; LBBB, left bundle branch block; PPM, permanent pacemaker; and RBBB, right bundle branch block.