24
Treatment
(cont'd) 7.2. Patient Selection for ICD Placement
COR LOE
Recommendations
1 C-EO
1. In patients with HCM, application of individual clinical
judgment is recommended when assessing the prognostic
strength of conventional risk marker(s) within the clinical
profile of the individual patient, as well as a thorough
and balanced discussion of the evidence, benefits, and
estimated risks to engage the fully informed patient's active
participation in ICD decision-making.
1 B-NR
2. For patients with HCM and previous documented cardiac
arrest or sustained VT, ICD placement is recommended
(Figure 3, Table 7).
2a B-NR
3. For adult patients with HCM with ≥1 major risk factors
for SCD, it is reasonable to offer an ICD. These major risk
factors include (Figure 3, Table 7):
a. Sudden death judged definitively or likely attributable to
HCM in ≥1 first-degree or close relatives who are ≤50
years of age;
b. Massive LVH ≥30 mm in any LV segment;
c. ≥1 recent episodes of syncope suspected by clinical history
to be arrhythmic (ie, unlikely to be of neurocardiogenic
[vasovagal] etiolog y, or related to LVOTO);
d. LV apical aneurysm with transmural scar or LGE;
e. LV systolic dysfunction (EF <50%).
2a B-NR
4. For children with HCM who have ≥1 conventional risk
factors, including unexplained syncope, massive LVH,
NSVT, or family history of early HCM-related SCD, ICD
placement is reasonable after considering the relatively high
complication rates of long-term ICD placement in younger
patients (Figure 3, Table 7).
2a B-NR
5. For patients with HCM with ≥1 major SCD risk factors,
discussion of the estimated 5-year sudden death risk and
mortality rates can be useful during the shared decision-
making process for ICD placement (Figure 3, Table 7).
2b B-NR
6. In select adult patients with HCM and without major SCD
risk factors after clinical assessment, or in whom the decision
to proceed with ICD placement remains otherwise uncertain,
ICD may be considered in patients with extensive LGE
by contrast-enhanced CMR imaging or NSVT present on
ambulatory monitoring (Figure 3, Table 7).
