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HFrEF with LBBB — EECC MCQ

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HardHeart FailureHFrEF with LBBBEECC

A 70-year-old man with HFrEF (LVEF 28%) and LBBB (QRS 156 ms) in sinus rhythm is on optimal medical therapy. He remains NYHA class III. His blood pressure is 110/70 mmHg. He has no history of sustained ventricular arrhythmia or cardiac arrest. What device therapy is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Cardiac resynchronisation therapy with defibrillator (CRT-D)

Explanation lettering: B = shown as A · D = shown as B · A = shown as C · E = shown as D · C = shown as E

Per the 2021 ESC HF Guidelines and cardiac pacing guidelines, CRT is recommended (Class I, LOE A) for symptomatic HF patients in sinus rhythm with LVEF 35% or below, LBBB morphology, and QRS 150 ms or above, despite 3 or more months of optimal medical therapy. CRT-D combines resynchronisation with defibrillation capability and is generally preferred in patients with reasonable life expectancy. An ICD alone (A) would miss resynchronisation benefit. CRT-P (C) may be considered in older patients. S-ICD (D) provides no pacing. No device (E) would miss a Class I indication.

Reference: ESC (2021): Guidelines on Cardiac Pacing and Cardiac Resynchronisation Therapy