Thirty Controversies and Considerations in Hypertrophic Cardiomyopathy

More than 60 years after the first description of "asymmetric septal hypertrophy of the heart," hypertrophic cardiomyopathy (HCM) as a disease has continued to provide clinicians and researchers fertile grounds for debate and investigation. HCM, as a complex disease requiring a multidisciplinary approach, runs the gamut of all we learned in medical school and beyond - physiology, clinical medicine, genetics, imaging, diagnostics, pharmacotherapies, electrophysiology, interventional cardiology, and cardiothoracic surgical interventions. In this review, we discuss 30 contemporary controversies and considerations in HCM.Abbreviations: HCM: hypertrophic cardiomyopathy; LVH: left ventricular hypertrophy; nHCM: non-obstructive hypertrophic cardiomyopathy; oHCM: obstructive hypertrophic cardiomyopathy; LVOTO: left ventricular outflow tract obstruction; MVA: mitral valve apparatus; P: phenotype; G: genotype; MYH7: myosin heavy chain 7; MYPBC3: myosin binding protein C, cardiac type; ECG: electrocardiogram; SCD: sudden cardiac death; MR: mitral regurgitation; LA: left atrium; AF: atrial fibrillation; CMR: cardiac magnetic resonance imaging; LGE: late gadolinium enhancement; ICD: implantable cardioverter-defibrillator; ECV: extracellular volume; CPET: cardio-pulmonary exercise testing; SRT: septal reduction therapy; FDR: first-degree relative; NYHA: New York Heart Association; DOAC: direct oral anticoagulants; OAC: oral anticoagulants; AAD: anti-arrhythmic drugs; NSVT: non-sustained ventricular tachycardia; ACC: American College of Cardiology; AHA: American Heart Association; ESC: European Society of Cardiology; LVEF: left ventricular ejection fraction; S-ICD: subcutaneous implantable cardioverter-defibrillator; IAS: inappropriate shock; AVB: atrio-ventricular block; CHB: complete heart block; VT: ventricular tachycardia; ASA: alcohol septal ablation; ATP: anti-tachycardia pacing; TE: thromboembolism; SAM: systolic anterior motion; LBBB: left bundle branch block.