Prof Valentina Kutyifa (University of Rochester, Rochester, MA, US) and Dr Kamala Tamirisa (UT Southwestern Medical Center, Dallas, TX, US) join us to explore the clinical challenges of device therapy selection in patients with competing indications, sharing practical frameworks for navigating this increasingly prevalent scenario in contemporary electrophysiology practice.

As the complexity of cardiac device candidates continues to grow, clinicians are frequently confronted with patients whose clinical profiles span multiple competing indications — from advanced heart failure and reduced ejection fraction to significant arrhythmia burden, conduction disease, and comorbid conditions that complicate risk stratification. Selecting the optimal device strategy in this setting demands careful integration of guideline evidence, individual patient factors, and emerging data from dedicated trials.

In this discussion, Prof Kutyifa and Dr Tamirisa examine the key decision points encountered in clinical practice, address areas of guideline uncertainty, and discuss how evolving evidence is shaping the approach to device therapy in the most challenging patient populations.

Recorded on-site at HRS 2025, Chicago.
Editors: Jordan Rance
Videographer: Oliver Miles, David Ben-Harosh
Support: This is an independent discussion produced by Radcliffe Cardiology.