Recommendations of the current guidelines for implantable cardioverter-defibrillator implantation in patients with hypertrophic cardiomyopathy: Debate still exists

Sudden cardiac death (SCD) related to ventricular arrhythmias is the most disastrous consequence of hypertrophic cardiomyopathy (HCM). Hence, clinicians seek to identify the highest risk patients that have the greatest potential to benefit from an implantable cardioverter-defibrillator (ICD) for primary prevention; nonetheless, this is where controversies begin as the 2011 American College of Cardiology Foundation/American Heart Association and the 2014 European Society of Cardiology guidelines have significant discrepancies. These guidelines propose clinically and statistically oriented algorithms, respectively, for SCD risk stratification of patients with HCM and recommendation to implantation of primary prevention ICD. The differences between these guidelines have resulted in confusion among care practitioners and patients alike. In this communication, we tried to criticize the statistical viewpoint in terms of clinical outcomes and suggest the more beneficial model.