Aim: The aim of this study was to assess the long-term outcomes of patients who underwent repeated septal reduction therapy after a first alcohol septal ablation. Methods and Results: We evaluated consecutive patients who underwent ASA (n=1385) and identified 145 (10%) patients who later on underwent repeated septal reduction therapy. The mean clinical follow-up period was 6.5±4.1 years. Patients who required repeated septal reduction therapy had a higher left ventricular outflow gradient and a thicker interventricular septum at baseline (both p<0.01), but the long-term occurrence of major cardiovascular adverse events was similar in both groups (p=0.17). The group of patients who underwent repeated treatment had a higher number of pacemakers (26% vs. 16%; p<0.01). Conclusions: Repeated septal reduction after the initial ASA was not associated with greater risk of cardiovascular adverse events in the long-term follow-up. However, these patients required pacemaker implantation more often.