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CRT-P for End-Stage HF — RACP Adult Medicine MCQ

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HardCardiologyCRT-P for End-Stage HFRACP Adult Medicine

A 78-year-old woman with HFrEF (LVEF 30%) and NYHA class IV (ambulatory) has a QRS of 170 ms with LBBB. She has severe renal impairment and multiple comorbidities with an estimated life expectancy of <12 months. She is not a transplant candidate. What device therapy is most appropriate?

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Correct answer: C — CRT-P (cardiac resynchronisation pacemaker without defibrillator)

With very limited life expectancy (<12 months) and NYHA class IV, the defibrillator component offers limited benefit (preventing SCD is less meaningful when death from pump failure is imminent). CRT-P (pacemaker only, without defibrillator) provides symptom benefit from resynchronisation without the burden and cost of an ICD. This is a goals-of-care discussion.

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