In June 1994, Ulrich Sigwart injected a small quantity of absolute alcohol into the first septal artery of a 67 year old woman with hypertrophic obstructive cardiomyopathy.1 The objective of this somewhat alarming manoeuvre was to produce an area of localised myocardial infarction in the left ventricular outflow tract—in effect producing a chemical myotomy–myectomy, without recourse to open heart surgery. Five years on, the technique has been applied by a number of groups in a few hundred patients worldwide.

The birth of the Sigwart procedure (percutaneous transluminal septal myocardial ablation, transcoronary ablation of septal hypertrophy, non-surgical septal reduction) was not greeted with unanimous approval from the community of physicians treating patients with this troublesome condition. A number of eminent commentators have referred to the procedure's “profoundly aggressive” nature and its associated “unacceptably high mortality and morbidity”.2 Clearly such comments were made at a very early point in the technique's development; it is now five years old, what do we know of the results of this interventional “enfant terrible” and how safe is it?

Information is still restricted to data from relatively few patients with (inevitably) only medium term follow up. There have been five reports of the short term results of the procedure involving just under 200 patients,3-7 and three longer term (7–30 months) reports7-9 in fewer than 100 patients—one of which (Faber …