38
Treatment
8.5. Management of Patients With HCM and Ventricular
Arrhythmias
COR LOE
Recommendations
1 B-NR
1. In patients with HCM and recurrent, poorly tolerated
life-threatening ventricular tachyarrhythmias refractory to
maximal antiarrhythmic drug therapy and ablation, heart
transplantation assessment is indicated in accordance with
current listing criteria.
1
B-NR*
2. In adults with HCM and symptomatic ventricular
arrhythmias or recurrent ICD shocks despite beta-blocker
use, antiarrhythmic drug therapy (eg, amiodarone,*
dofetilide,
†
mexiletine,
†
or sotalol
†
) is recommended, with
the choice of agent guided by age, underlying comorbidities,
severity of disease, patient preferences, and balance between
efficacy and safety.
C-LD
†
1 C-LD
3. In children with HCM and recurrent ventricular arrhythmias
despite beta-blocker use, antiarrhythmic drug therapy (eg,
amiodarone, mexiletine, sotalol) is recommended, with the
choice of agent guided by age, underlying comorbidities,
severity of disease, patient preferences, and balance of efficacy
and safety.
1 C-LD
4. In patients with HCM and pacing-capable ICDs,
programming antitachycardia pacing is recommended to
minimize risk of shocks.
2a C-LD
5. In patients with HCM and recurrent symptomatic sustained
monomorphic VT, or recurrent ICD shocks despite optimal
device programming, and in whom antiarrhythmic drug
therapy is either ineffective, not tolerated, or not preferred,
catheter ablation can be useful for reducing arrhythmia
burden.
* Indicates the LOE for amiodarone.
†
Indicates the LOE for dofetilide, mexiletine, or sotalol.
