Abstract: Obstructive hypertrophic cardiomyopathy (oHCM) is an inherited heart disease primarily caused by mutations in the gene that encodes myosin. Conventional pharmacological interventions focus on symptom relief rather than addressing the underlying pathophysiological mechanisms. In recent years, the development of cardiac myosin inhibitors has introduced a new therapeutic approach for managing oHCM. In comparison to Mavacamten, Aficamten, a second-generation myosin inhibitor, specifically binds to a distinct site on cardiac myosin, thereby inhibiting excessive myocardial contraction. This in turn alleviates left ventricular outflow tract obstruction and reduces clinical symptoms. This article reviews the mechanism of oHCM, the action mechanism of Aficamten, and the progress in clinical research on Aficamten.