Hi, In the case of an enlarged heart, the stretch that is imposed on the heart muscle makes these cells move away from each other and this space between them is replaced with non-functional, non electricıty conductive fibrotic tissue. This is the hallmark that makes these hearts prone to severe, serious, life-threatening ventricular arrhythmias, which can be triggered at any moment. Therefore, in my opinion, an implantable cardioverter-defibrillator (ICD) should be placed to prevent death from these arrhythmias, should they occur. The other alternative is maximizing the antiarrhythmic medication to prevent the occurrence of arrhythmias. Although, at these figures of heart function, they can be effective only to a certain amount. My opinion is that even if he does not undergo an ICD placement, he will have his license lost, because of the high risk of these arrhythmias. Hope I have answered your query. Let me know if I can assist you further.