A 45-year-old man with dilated cardiomyopathy (EF 28%) is on optimal medical therapy (ACEi, beta-blocker, MRA, SGLT2i). He has LBBB with QRS duration 158 ms and NYHA Class III symptoms. Which device therapy is most indicated?

• A Implantable cardioverter-defibrillator (ICD) alone
• B Wearable cardioverter-defibrillator
• C Cardiac resynchronization therapy with defibrillator (CRT-D) ✓
• D Implantable loop recorder

Explanation

CRT-D is indicated for symptomatic HFrEF (EF ≤35%) with LBBB morphology and QRS ≥150 ms on optimal medical therapy (Class I, ESC/ACC/AHA guidelines). LBBB with QRS ≥150 ms is the strongest predictor of CRT response. CRT improves symptoms, exercise tolerance, LVEF, and reduces mortality and HF hospitalizations. ICD alone does not address dyssynchrony. The combination of CRT and ICD (CRT-D) is preferred when primary prevention ICD indication also exists (EF ≤35%).

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.