26
Treatment
Figure 3. Patient Selection for ICD Use
An ICD is
recommended
(1)
* ICD decisions in pediatric patients with HCM are based on ≥1 of these major risk
factors: family history of HCM SCD, NSVT on ambulatory monitor, massive LVH, and
unexplained syncope.
†
5-Year risk estimates can be considered to fully inform patients during shared decision-
making discussions.
‡
It would seem most appropriate to place greater weight on frequent, longer, and faster runs
of NSVT.
CMR indicates cardiovascular magnetic resonance; EF, ejection fraction; FH, family history;
HCM, hypertrophic cardiomyopathy; ICD, implantable cardioverter-defibrillator; LGE,
late gadolinium enhancement; LVH, le ventricular hypertrophy; NSVT, nonsustained
ventricular tachycardia; SCD, sudden cardiac death; VF, ventricular fibrillation; and VT,
ventricular tachycardia.
NSVT *
†‡
An ICD is reasonable
(2a)
An ICD may be
considered
(2b)
An ICD is not
indicated
(3: Harm)
NO
NO
NO
NO
Prior event
(SCD, VF,
sustained VT)
YES
YES
YES
YES
Adults
Extensive LGE
on CMR
Children
At least 1 of the
following:
• FH SCD*
• Massive LVH*
• Unexplained
syncope*
• Apical aneurysm
• EF <50%
5-Year risk
estimate
for shared
decision-
making
(2a)
5-Year risk
estimate
for shared
decision-
making
(2a)
