This session focuses on the nuanced decision-making required for patients with atypical Heart Failure with reduced Ejection Fraction (HFrEF). By analysing a case of non-ischemic dilated cardiomyopathy, the panel explores the critical transition from escalating medical therapy to the implantation of Cardiac Implantable Electronic Devices (CIED).
Effective management begins with advanced risk stratification for sudden cardiac death. Cardiac MRI has become a pivotal tool for identifying myocardial fibrosis, supplemented by electrophysiological studies and genetic testing. These diagnostics are essential in borderline cases where QRS duration or morphology makes the indications for ICD or CRT implantation less clear.
The discussion highlights a shift toward individualised pacing strategies, including His bundle pacing (HBP) and "hot" CRT, to optimise ventricular synchrony. Furthermore, the integration of atrial fibrillation (AF) and ventricular tachycardia (VT) ablation is debated not just for rhythm control, but as a means to improve patient tolerance for guideline-directed medical therapy (GDMT). This interdisciplinary approach ensures that device therapy and pharmacology work synergistically to improve long-term remodeling.
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