A 52-year-old woman with newly diagnosed heart failure with reduced ejection fraction (HFrEF, LVEF 28%) is started on guideline-directed medical therapy. Despite optimized doses of ACE inhibitor and beta-blocker, her LVEF remains 30% and NYHA class remains III. She is in sinus rhythm at 78 bpm. QRS duration is 118 ms (narrow). NT-proBNP is 2,800 pg/mL. She has no history of syncope. What additional device therapy should be considered?

• A Cardiac resynchronization therapy (CRT)
• B Wearable cardioverter defibrillator (WCD)
• C Cardiac transplant listing immediately
• D Implantable cardioverter defibrillator (ICD) ✓

Explanation

ICD implantation is recommended for primary prevention of sudden cardiac death in HFrEF patients with LVEF ≤35% despite ≥3 months of optimal medical therapy, NYHA class II–III, and expected survival >1 year. CRT requires LBBB morphology with QRS ≥150 ms (or QRS 120–149 ms with LBBB) — this patient has a narrow QRS of 118 ms without LBBB, so CRT is not indicated. WCD is a bridge option for newly diagnosed HFrEF awaiting LVEF reassessment at 3 months. After adequate medical optimization, this patient qualifies for ICD.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.