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ICD Deactivation After CRT Response — EECC MCQ

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ModerateCardiac DevicesICD Deactivation After CRT ResponseEECC

A 58-year-old man with HFrEF (LVEF 28%) and LBBB (QRS 152 ms) receives CRT-D. At 6-month follow-up, LVEF has improved to 42% and he is in NYHA class I. He asks whether the ICD component can be deactivated since he is doing well. What is the appropriate response?

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Correct answer: B — The ICD should remain active; LVEF improvement does not eliminate the risk of sudden cardiac death, and ICD therapies may still be needed

While CRT response with LVEF improvement is associated with better prognosis, it does not eliminate the risk of SCD. Studies have shown that even 'super-responders' (LVEF recovery >45%) can still experience malignant ventricular arrhythmias, particularly in ischaemic cardiomyopathy where arrhythmogenic scar persists. The ESC VA/SCD Guidelines do not recommend routine ICD deactivation based on LVEF recovery. GDMT should also be continued, as the TRED-HF trial showed that medication withdrawal in recovered cardiomyopathy leads to relapse in ~40% of cases within 6 months. ICD generator change decisions (CRT-D vs CRT-P) at battery replacement are more nuanced and should be individualised.

Reference: ESC (2022): Guidelines on VA and SCD Prevention; TRED-HF Trial