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Primary Prevention ICD — RACP Adult Medicine MCQ

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ModerateCardiologyPrimary Prevention ICDRACP Adult Medicine

A 55-year-old man with dilated cardiomyopathy (LVEF 20%) and NYHA class III has a narrow QRS (95 ms) on ECG. He is on optimal medical therapy. He has a family history of sudden cardiac death. He has not had sustained VT or cardiac arrest. What device therapy is most appropriate?

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Correct answer: C — ICD alone

HFrEF (LVEF ≤35%) with narrow QRS (<120 ms) does not qualify for CRT (no dyssynchrony benefit). However, LVEF ≤35% with NYHA II-III on optimal therapy is an indication for primary prevention ICD (SCD-HeFT, DANISH trials). ICD alone is appropriate. Family history of SCD adds further weight to the indication. The DANISH trial showed less benefit in non-ischaemic DCM, but it remains guideline-recommended.

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