Patients with hypertrophic cardiomyopathy may present with a number of arrhythmias. Although not unique, arrhythmias in hypertrophic cardiomyopathy require management approaches that may differ from other populations. Standard permanent pacemaker indications can be seen, but unique applications and implantation considerations pertain to this population. Ventricular and supraventricular tachyarrhythmias may be experienced by patients with hypertrophic cardiomyopathy, treatment for which must be tailored to the hypertrophic cardiomyopathy substrate. In this article, permanent pacemaker indications, techniques and special considerations, and specific management issues of ventricular and supraventricular tachyarrhythmias in hypertrophic cardiomyopathy, are discussed.