Implantation of ICD in a patient with heart failure with mildly reduced ejection fraction

Heart failure affects approximately 2% of the adult population in developed countries, with prevalence escalating to 10% among those aged over 70 years. Patients with Heart Failure with Mildly Reduced Ejection Fraction (HFmrEF) exhibit a risk profile comparable to those with reduced ejection fraction (EF), necessitating their classification as high-risk and tailoring therapeutic goals accordingly. The clinical case presented here of a patient with HFmrEF and elevated arrhythmic risk underscores the need for refining indications for primary prevention of sudden cardiac death (SCD). Furthermore, there is an imperative to identify and validate a panel of investigations to guide decision-making for patients with borderline indications for high-voltage device implantation. This approach aims to optimize the benefit-to-risk ratio for these individuals.