How do you decide when to refer patients with obstructive hypertrophic cardiomyopathy for alcohol septal ablation versus septal myectomy?   

If a patient with obstructive HCM remains severely symptomatic despite being on maximal standard-of-care medical therapy, (beta blockers, non-dihydropyridine calcium channel blockers, addition of disopyramide for combination therapy, or a cardiac myosin inhibitor if appropriate), septal reduction th...