The use of synchronized atrioventricular (AV) pacing devices and implantable cardioverter-defibrillators (ICDs) plays a critical role in the management of hypertrophic cardiomyopathy (HCM). Indications for pacing and defibrillators follow the standard guidelines for treatment of conduction disease and arrhythmias in the general population, with distinct additional indications for HCM patients based on the potential to mitigate diastolic dysfunction and outflow tract gradients and the potential to prevent and treat life-threatening ventricular arrhythmia and sudden cardiac death. ICDs can be a life-saving therapy in high-risk HCM patients, but the early placement of these devices in younger patients may expose them to a higher lifetime risk of complications. Given the unique nature of HCM, specific procedural and programming considerations should be taken into account.