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7.1.1. SCD Risk Assessment in Adults With HCM
COR LOE
Recommendations
1 B-NR
1. In adult patients with HCM, a comprehensive, systematic
noninvasive SCD risk assessment at initial evaluation and
every 1 to 2 years thereafter is recommended and should
include evaluation of these risk factors (Figure 1, Figure 3,
Table 7):
a. Personal history of cardiac arrest or sustained ventricular
arrhythmias;
b. Personal history of syncope suspected by clinical history to
be arrhythmic;
c. Family history in close relative of premature HCM-related
sudden death, cardiac arrest, or sustained ventricular
arrhythmias;
d. Maximal LV wall thickness, EF, LV apical aneurysm;
e. NSVT episodes on continuous ambulatory
electrocardiographic monitoring.
1 B-NR
2. For adult patients with HCM who are not otherwise
identified as high risk for SCD, or in whom a decision
to proceed with ICD placement remains uncertain after
clinical assessment that includes personal/family history,
echocardiography, and ambulatory electrocardiographic
monitoring, CMR imaging is beneficial to assess for
maximum LV wall thickness, EF, LV apical aneurysm, and
extent of myocardial fibrosis with LGE (Table 7).
2a B-NR
3. For patients who are ≥16 years of age with HCM, it is
reasonable to obtain echocardiography-derived left atrial
diameter and maximal LVOT gradient to aid in calculating
an estimated 5-year sudden death risk that may be useful
during shared decision-making for ICD placement (Table 7).
7. SCD Risk Assessment and Prevention
7.1. SCD Risk Assessment
