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While the procedure is being performed targeting the ablation of the focus of VT, the pressure gradient is being monitored. The procedure may also be useful to reduce the subaortic dynamic gradient, but we should remember that we need to wait for a full year before confirming that it has been effective. However, if the gradient does not fall in the cath. lab, we can use the procedure to test the first septal branch, inflate the balloon in its proximal sub-branch, for ultrasound-guided contrast infusion, to see if the basal septum opacifies in contact with the anterior mitral leaflet and to see what’s happening with the gradient. If the gradient does fall, we would have confirmation that such septal branch is causing the gradient, which is important for an eventual procedure if the patient’s functional class gets worse.

Bail-out alcohol septal ablation in the management of obstructive hypertrophic cardiomyopathy and refractory electrical storm