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HFrEF - ICD indication — EECC MCQ

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ModerateHeart FailureHFrEF - ICD indicationEECC

A 60-year-old man with ischaemic HFrEF (LVEF 22%) has completed 3 months of optimal medical therapy including sacubitril/valsartan, carvedilol, eplerenone, and empagliflozin. He is in sinus rhythm with narrow QRS (98 ms). He has had no sustained ventricular arrhythmia. He is NYHA class II. What device therapy is recommended for primary prevention of sudden cardiac death?

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Correct answer: D — Transvenous single-chamber ICD

Explanation lettering: C = shown as B · B = shown as C

Per the 2021 ESC HF Guidelines, an ICD is recommended for primary prevention of SCD in patients with symptomatic HFrEF (NYHA II-III) with LVEF 35% or below of ischaemic aetiology, despite 3 or more months of optimal medical therapy, if expected to survive more than 1 year (Class I, LOE A). With narrow QRS, CRT is not indicated (E). S-ICD (A) is an option but transvenous ICD is the default. A wearable defibrillator (C) is for specific situations. No device (D) would miss a Class I indication.

Reference: ESC (2021): Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure