6th May 2025

Non-pharmacological therapy

Patients can also be considered for cardiac resynchronisation therapy (CRT) or an implantable cardioverter defibrillator (ICD). CRT is indicated in patients who remain symptomatic on optimum medical therapy, with low LVEF of <35% and a QRS duration of >120ms. Biventricular pacing through CRT decreases the risk of heart failure events, improves cardiac function and can reverse left ventricular remodelling.

ICD is indicated in patients with a low LVEF <35%, previous ventricular tachycardia and symptoms no worse than NYHA Class III. ICD has been shown to increase survival in heart failure by 23% (SCD-HeFT).

These two devices can also be combined into a CRT-D (cardiac resynchronisation therapy – defibrillator) and has been shown to reduce the progression of heart failure in patients with NYHA I/II.