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Background Risk stratification for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) remains challenging. Programmed electrical stimulation (PES) is not endorsed by current guidelines, and its role in risk stratification is debated. We conducted a systematic review and meta-analysis to assess the association between PES inducibility and major arrhythmic events (MAE) in patients with HCM and evaluate its predictive value.Methods We searched PubMed/MEDLINE, Embase and the Cochrane Library up to 1 February 2024, for studies assessing MAE (SCD, resuscitated cardiac arrest or appropriate implantable cardioverter-defibrillator interventions) according to PES inducibility. A random-effects meta-analysis was performed to calculate pooled ORs and CIs. Sensitivity, specificity and predictive values were also calculated from the published information.Results Five studies (587 patients, 66% male, mean age 38±14 years) were included. PES inducibility was observed in 188 (32%) patients. MAE occurred in 18% of inducible patients (34 events) and 2% of non-inducible patients (8 events) (OR 10.83, 95% CI 3.52 to 33.34, p<0.001, I²=27%). The sensitivity of PES for MAE was 81%, specificity was 72%, positive predictive value was 18%, and negative predictive value was 98%.Conclusion PES inducibility is associated with a 10 times higher risk of MAE in patients with HCM. Further prospective studies are needed to validate its independent predictive value in the context of contemporary risk stratification tools.PROSPERO registration number CRD42024497521.