A 45-year-old man with heart failure has an EF of 30%, LBBB with QRS 158 ms, and sinus rhythm despite optimal GDMT for 3 months. Per ACC/AHA 2022 guidelines, which device therapy is indicated (Class I)?

• A ICD alone
• B CRT-D (cardiac resynchronisation therapy with defibrillator) ✓
• C Wearable cardioverter defibrillator
• D CRT-P (pacemaker only without ICD function)

Explanation

CRT-D is indicated (Class I, Level A) in HFrEF patients with EF ≤35%, LBBB morphology with QRS ≥150 ms, sinus rhythm, and NYHA Class II–III symptoms despite optimal GDMT for ≥3 months. LBBB with QRS ≥150 ms predicts the best response to CRT (reverse remodelling, reduced HF hospitalisations and mortality — CARE-HF, MADIT-CRT trials). CRT-P (without ICD) is considered when ICD benefit is uncertain (e.g., ischaemic CM with significant comorbidities). ICD alone does not address dyssynchrony. QRS ≥158 ms in LBBB strongly supports CRT-D implantation.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.