Patients with nonischemic cardiomyopathy requiring cardiac resynchronization therapy should also undergo implantation of a primary prevention defibrillator: the con perspective.

This article describes a 45-year-old lady with longstanding dilated cardiomyopathy, who has progressed to New York Heart Association class III and has failed to respond to optimal pharmacologic therapy. On the basis of gender and the presence of an left bundle branch block, she has good prospects of responding to cardiac resynchronization therapy. In the background of nonischemic cardiomyopathy and the absence of myocardial scarring on cardiovascular magnetic resonance, her annualized risk of sudden cardiac death is low, estimated at 2.6%.