Transmyocardial laser revascularization is emerging as a treatment option for patients with debilitating angina pectoris and no conventional treatment option. Results with the high powered CO2 laser have been reproducibly encouraging. As the mechanism of action remains uncertain, the importance of the type of laser used is unknown. Interest in developing less invasive approaches, ultimately including catheter-based technologies, has stimulated the evaluation of alternative laser energy sources with fiberoptic delivery systems. One such device is the holmium:YAG laser. Clinical experience with the holmium:YAG-based systems is still in its early stages. We review our experience with one such device and the existing literature on the subject. We also briefly describe experimental evidence that this device is capable of denervating the heart locally.