Objective The management of hypertrophic obstructive cardiomyopathy is not well-defined in the elderly. Medical therapy with (3-blockers and calcium-channel blockers are the mainstay therapy for symptomatic patients. Myomectomy is usually reserved for patients who fail medical therapy. Alcohol septal ablation has been recently in-troduced as an alternative therapy. Patients and Methods Ninety-five patients older than 65 years of age were included. All patients have completed one year of follow-up. The mean age was 72 ± 5 years, 47 patients were fe-males , 10 patients with history of hypertension. Results The mean rise in CK post alcohol ablation was 1052 ± 430 IU. The mean NYHA class decreased from 2.9±0.6tol.2±0.5 ( P < 0.001). The exercise duration on tread-mill testing increased from 328 ± 260 s to 349 ± 39 s. The mean resting left ventricular outflow tract gradient de-creased from 65 ± 37 inmHg to 16 ± 29 inmHg at one year. One patient died in the hospital after coronary artery by-pass grafting that was done subsequent to spiral dissection of the left anterior descending artery during ablation. Thir-teen patients developed complete heart block immediately after ablation requiring pacing therapy. Conclusions Al-cohol septal ablation seems to be an effective alternative therapeutic option for elderly patients with hypertrophic ob-structive cardiomyopathy. Larger studies with longer follow-up are needed.