What are the current indications for ICD implantation in patients with heart failure with reduced EF?

1 Answer

ICD Indications in HFrEF (ACC/AHA Guidelines): Primary Prevention ICD (Class I): - EF ≤35% despite ≥3 months of optimal medical therapy (OMT) - NYHA Class II or III symptoms - Expected meaningful survival >1 year - Ischemic or non-ischemic cardiomyopathy CRT-D Indications (Class I): - EF ≤35% + LBBB with QRS ≥150 ms + NYHA Class II-IV - EF ≤35% + non-LBBB with QRS ≥150 ms + NYHA Class III-IV (Class IIa) ICD Alone vs CRT-D: - CRT-D preferred if QRS ≥150 ms with LBBB (both resynchronization + defibrillation benefit) - ICD alone if no CRT indication but EF ≤35% When NOT to implant ICD: - NYHA Class IV (non-ambulatory) unless transplant/LVAD candidate - Recent MI <40 days (wait and reassess after OMT) - Newly diagnosed cardiomyopathy (wait 3 months of OMT) - Severe non-cardiac comorbidities limiting survival For this patient: EF 28%, 6 months OMT - check NYHA class and QRS width. If NYHA II-III and QRS <130ms: ICD alone. If QRS ≥150ms with LBBB: CRT-D.