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CRT-D Indication in HFrEF — RACP Adult Medicine MCQ

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HardCardiologyCRT-D Indication in HFrEFRACP Adult Medicine

A 70-year-old man with ischaemic cardiomyopathy (LVEF 25%) and NYHA class II symptoms on optimal medical therapy (ramipril, bisoprolol, eplerenone, dapagliflozin) has a QRS duration of 160 ms with LBBB morphology on ECG. He has not had a cardiac arrest. What device therapy is most appropriate?

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Correct answer: E — CRT-D (cardiac resynchronisation with defibrillator)

HFrEF (LVEF ≤35%) with LBBB and QRS ≥150 ms on optimal medical therapy is a Class I indication for CRT. Given LVEF ≤35% also qualifies for ICD (primary prevention of SCD in ischaemic cardiomyopathy), CRT-D (combined CRT + ICD) is the most appropriate device. CRT improves symptoms, reduces hospitalisations, and may improve LVEF (reverse remodelling).

Reference: NHFA/CSANZ – 2023 – Heart Failure; ESC 2021 CRT Guidelines