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©2013 UpToDate ® Print Email ACC/AHA/HRS: Pacing indications for hypertrophic cardiomyopathy Class I - There is evidence and/or general agreement that permanent pacing is indicated in patients with hypertrophic cardiomyopathy in the followng setting: • Class I indications for sinus node dysfunction or AV block as previously described. (Level of Evidence: C) Class IIb - The evidence or opinion is less well established that permanent pacing in hypertrophic cardiomyopathy is beneficial in the following setting: • Medically refractory, symptomatic patients with significant resting or provoked LV outflow tract obstruction. (Level of Evidence: A) As for Class I indications, when risk factors for SCD are present, consider a DDD ICD. Class III - There is evidence that permanent pacing in hypertrophic cardiomyopathy is not useful and may be harmful in the following settings: • Patients who are asymptomatic or or whose symptoms are medically controlled. (Level of Evidence: C) • Symptomatic patients without evidence of LV outflow tract obstruction. (Level of Evidence: C) Adapted from: Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350.