Objectives. Reports of long-term survival and the risk of sudden cardiac death (SCD) after percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) are sparse. Design. Survival and SCD in 77 PTSMA-treated patients (follow-up 3.5 ± 2.8 years) were analyzed. The future risk of SCD was assessed by risk stratification for SCD in 57 PTSMA patients at long-term follow-up (3.8 ± 2.8 years). Results. The five years survival of the PTSMA cohort (age 61 ± 12 years) was 83% compared to 79% in a control cohort (n = 90) of patients (age 52 ± 17 years) with hypertrophic cardiomyopathy (HCM) (Log Rank p = 0.8), and 91% (p = 0.01) in the background population. Five-year survival free of SCD was 94% after PTSMA compared to 99% (p = 0.13) in the HCM control cohort. Eight percent of patients had two or more risk factors for SCD at follow-up. Conclusion. The survival in the PTSMA-treated patients and in the HCM control cohorts was similar. The incidence of SCD and the future risk of SCD assessed by risk factors were not increased in the PTSMA cohort compared to the HCM control cohort. The excess mortality in the PTSMA cohort compared to the background population seems to be related to HCM rather than PTSMA.