Objective To compare the effects of septal ablation (SA) versus conservative medication (CM) on the hemodynamic, clinical status and survival in patients with hypertrophic obstmctive cardiomyopathy (110CM) . Methods This retrospective study included 350 consecutive patients with 110CM (mean age (51. 3 ± 13. 5) years old) hospitalized in Anzhen Hospital between September 2002 to September 2014. The patients were followed up to 14 years and the follow up rate was 99. 4% (348/350). Overall and cardiac-related mortalities were compared between SA group (n = 184) and CM group (n = 184). Moreover, SA related cardiac function and hemodynamies improvement were also evalaated, predictors for clinical events were evaluated by Cox regression analysis and Kaplan-Meier survival analysis was used to compare tile total mortality between the two groups. The log-rank test was used to compare the survival curve differences between the two groups. Results The median follow-up period was 4 years (1 - 14 years). The annual mortalities of SA and CM were 2.4% and 0. 6% respectively (P <0. 001) and cumulative sudden cardiac death (SCD) rates were 3.61% (6/166) and 0.54% (1/184) respectively (P = 0. 031). Multivariate regression analysis demonstrated that the age was the most important independent predictor for overall mortality (HR 1. 259 95% CI 1. 101 - 1. 438 , P = 0. 001). In addition, left ventricular outflow tract (LVO'l') gradient was significantly reduced post SA (peak velocity of LVOT: baseline (4. 23 ± 1.05) m/s, post SA; (1.83 ±0.79) m/s,P <0. 01) and heart fuoction was also significantly improved post SA (NYHA at baseline: 2.97 ± 0. 29, post SA; 1.74 ± 0.53, P <0.001). Conclusion SA could significantly improve the hemodynamics and clinical status in dmg-resistant patients with HOCM. In comparison to patients received CM, overall survival rate was significantly higher in SA group without extra risk of SCD. © 2016 by the Chinese Medical Association.