Reply to letter to the editor: "Long-term clinical outcomes after alcohol septal ablation for hypertrophic obstructive cardiomyopathy in Japan: a retrospective study".

We appreciate the comments from Arshad et al. regarding our study on long-term outcomes of alcohol septal ablation (ASA) for hypertrophic obstructive cardiomyopathy (HOCM) in Japan. Addressing concerns about sex-related differences, our analyses revealed no significant differences between men and women in overall mortality (log-rank P = 0.759) or major cardiovascular events (heart failure admission, P = 0.521; pacemaker/implantable cardioverter-defibrillator implantation, P = 0.234; sustained ventricular tachycardia/ventricular fibrillation, P = 0.615; new-onset atrial fibrillation, P = 0.894). The 12% reintervention rate is consistent with reported rates from high-volume centers over 10 years (10-15%), suggesting appropriate patient selection. Primary risk factors for reintervention were thicker interventricular septum and residual mitral regurgitation, as previously reported. Sustained efficacy of ASA is supported by 75% of patients maintaining NYHA class I at 10-year follow-up. These findings, while acknowledging potential differences between Japanese and Western populations, reinforce the long-term safety and effectiveness of ASA for HOCM in Japan.