A 44-year-old man with newly diagnosed dilated cardiomyopathy and LVEF 22% presents with non-sustained VT on Holter and an NYHA class II status after 6 weeks of optimal medical therapy. What is the threshold for primary prevention ICD implantation?

• A LVEF ≤ 40% with any ventricular ectopy
• B LVEF ≤ 30% regardless of GDMT duration
• C LVEF ≤ 35% within the first 4 weeks of diagnosis
• D LVEF ≤ 35% after at least 3 months of GDMT in patients with NYHA class II–III ✓

Explanation

Primary prevention ICD is indicated (ACC/AHA HF 2022, Class I) in patients with HFrEF (LVEF ≤ 35%) who have NYHA class II–III symptoms after at least 3 months of optimal GDMT, with life expectancy > 1 year. A minimum period of GDMT (3 months) is required because LVEF often improves substantially with therapy, potentially avoiding an unnecessary device. Implanting ICD within the first 4 weeks was shown to be non-beneficial in DINAMIT and IRIS trials. The threshold is 35%, not 40%.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.