Patients with severely symptomatic hypertrophic obstructive cardiomyopathy (HOCM) have several alternatives when drugs do not help. Surgical septal myotomymyectomy, though effective, is an open-heart surgical procedure and can be associated with some complications. The less invasive dual chamber pacing has not lived up to its early promise. Percutaneous transluminal septal myocardial ablation (PTSMA) is a relatively simple, less complicated nonsurgical procedure that can provide an effective and sustained relief of left ventricular outflow tract (LVOT) obstruction. Should it gain wider acceptance?