7.1.3.2 Device considerations in patients with HF after cardiac surgery

Recommendation 53: We recommend that after successful cardiac surgery, patients with HF undergo assessment for implantable cardiac devices within 3-6 months of optimal treatment (Strong Recommendation, High Quality Evidence).

Recommendation 54: We recommend that patients with implantable cardiac devices in situ should be evaluated for programming changes before surgery and again after surgery, in accordance with existing CCS recommendations (http://dx.doi.org/10.1016/j.cjca.2016.09.009) (Strong Recommendation, Low Quality Evidence).

• During surgical revascularization, consideration can be given to implantation of epicardial LV leads to facilitate biventricular pacing in eligible patients who might be candidates for CRT, especially if the coronary sinus anatomy is known to be unfavourable for lead placement.

7.1.3.2.1 ICD therapy to prevent sudden death in patients with hypertrophic cardiomyopathy (HCM)

Recommendation 55: We recommend patients with HCM who survive a cardiac arrest should be offered an implantable cardioverter defibrillator (ICD) (Strong Recommendation, Moderate Quality Evidence).

Recommendation 56: We recommend patients with HCM who have sustained ventricular tachycardia should be considered for an implantable cardioverter-defibrillator (ICD) (Strong Recommendation, Moderate Quality Evidence).

Recommendation 57: We suggest an estimate of risk for SCD in patients with HCM should be determined based on validated risk scores and/or the presence of one or more high risk clinical factors to select appropriate candidates for primary prevention implantable cardioverter-defibrillator therapy (Weak Recommendation, Moderate Quality Evidence).

Values and preferences: These recommendations place great value on the prevention of SCD in patients perceived to be at high risk from observational studies. Primary prevention implantable cardioverter-defibrillator recommendations in this population place significant weight on individualizing risk assessment whenever possible by clinicians/centers with significant experience in HCM, taking into consideration the potential for device complications.

• Emerging risk factors for SCD, including late gadolinium enhancement on cardiac MRI, specific genetic mutations and electrocardiographic features may be considered to modify estimate of risk on an individual basis by clinicians/centers with significant experience managing patients with HCM.