27
7.3. ICD Device Selection Considerations
COR LOE
Recommendations
1 B-NR
1. In patients with HCM who are receiving an ICD, either a
single chamber transvenous ICD or a subcutaneous ICD is
recommended after a shared decision-making discussion that
takes into consideration patient preferences, age, lifestyle, and
potential need for pacing for bradycardia or VT termination.
1 B-NR
2. In patients with HCM who are receiving a transvenous ICD,
single-coil ICD leads are recommended in preference to dual-
coil leads, if defibrillation threshold is deemed adequate.
2a B-NR
3. In patients with HCM who are receiving an ICD, dual-
chamber ICDs are reasonable for patients with a need for
atrial or atrioventricular sequential pacing for bradycardia/
conduction abnormalities, or as an attempt to relieve
symptoms of obstructive HCM (most commonly in patients
>65 years of age).
2a C-LD
4. In selected adult patients with nonobstructive HCM
receiving an ICD who have NYHA class II to ambulatory
class IV HF, left bundle branch block (LBBB), and LVEF
<50%, cardiac resynchronization therapy (CRT) for
symptom reduction is reasonable.
2b C-LD
5. In patients with HCM in whom a decision has been
made for ICD implantation and who have paroxysmal
atrial tachycardias or AF, dual-chamber ICDs may be
reasonable, but this decision must be balanced against higher
complication rates of dual-chamber devices.
