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 introduced 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 females, 10 patients with history of hypertension. Results The mean rise in CK post alcohol ablation was 1052 ± 430IU. The mean NYHA class decreased from 2.9 ± 0.6 to 1.2 ± 0.5 ( P ＜ 0.001 ). The exercise duration on treadmill testing increased from 328 ± 260 s to 349 ± 39 s. The mean resting left ventricular outflow tract gradient decreased from 65 ± 37 mmHg to 16 ± 29 mmHg at one year. One patient died in the hospital after coronary artery bypass grafting that was done subsequent to spiral dissection of the left anterior descending artery during ablation. Thirteen patients developed complete heart block immediately after ablation requiring pacing therapy. Conclusions Alcohol septal ablation seems to be an effective alternative therapeutic option for elderly patients with hypertrophic obstructive cardiomyopathy. Larger studies with longer follow-up are needed.