Which device is indicated to prevent sudden cardiac death in advanced heart failure when the ejection fraction is ≤ 35% and life expectancy > 1 year?

Which device is indicated to prevent sudden cardiac death in advanced heart failure when the ejection fraction is ≤ 35% and life expectancy > 1 year?

• A. Implantable cardioverter-defibrillator
• B. Cardiac resynchronization therapy with biventricular pacing
• C. Combined resynchronization therapy and defibrillator
• D. Mechanical circulatory support with ventricular assist devices (LVAD/biVAD)

Answer: (A)

An implantable cardioverter-defibrillator is used to prevent sudden cardiac death in patients with advanced heart failure who have a markedly reduced ejection fraction (≤35%) and a reasonable life expectancy (more than about a year). The ICD continuously monitors heart rhythms and delivers a shock or pacing therapy to terminate life‑threatening ventricular arrhythmias such as VT or VF, which are common causes of sudden death in this population. It doesn’t primarily improve heart failure symptoms; its main benefit is reducing mortality from arrhythmic death. Cardiac resynchronization therapy with biventricular pacing is considered when there is significant dyssynchrony (often a widened QRS) and HF symptoms, and it may be used with an ICD if defibrillation capability is also indicated (CRT‑D). Combined resynchronization therapy and defibrillator is reserved for those who meet both the dyssynchrony and arrhythmia risk criteria. Mechanical circulatory support with LVADs is for advanced HF as a bridge or destination therapy and does not specifically prevent sudden cardiac death from arrhythmias.

An implantable cardioverter-defibrillator is used to prevent sudden cardiac death in patients with advanced heart failure who have a markedly reduced ejection fraction (≤35%) and a reasonable life expectancy (more than about a year). The ICD continuously monitors heart rhythms and delivers a shock or pacing therapy to terminate life‑threatening ventricular arrhythmias such as VT or VF, which are common causes of sudden death in this population. It doesn’t primarily improve heart failure symptoms; its main benefit is reducing mortality from arrhythmic death.

Cardiac resynchronization therapy with biventricular pacing is considered when there is significant dyssynchrony (often a widened QRS) and HF symptoms, and it may be used with an ICD if defibrillation capability is also indicated (CRT‑D). Combined resynchronization therapy and defibrillator is reserved for those who meet both the dyssynchrony and arrhythmia risk criteria. Mechanical circulatory support with LVADs is for advanced HF as a bridge or destination therapy and does not specifically prevent sudden cardiac death from arrhythmias.