Hello. Thank you for your question and welcome to HCM. I understand your concern. There are various primary conditions of the heart muscle which have the dilated (enlarged) heart chambers as a complication. In your case, I come to understanding that this is from a damaged valve by endocarditis, with highest probability. Dilated cardiomyopathy is commonly accompanied by left bundle branch block, because of the delayed depolarization of the enlarged left ventricle. Every one with an left ventricle ejection fraction of under 35% should be seen as a candidate for implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy (CRT - biventricular pacemaker) implantation. ICD is implanted to prevent death from malignant ventricular arrhythmias, which have a fair probability to be triggered by the enlarged heart. Furthermore, CRT is used to synchronize both ventricles to beat simultaneously, and not in a delayed form. Studies show that there is more benefit from these procedures in enlarged hearts that do not have ischemia as a cause of enlargement, which, I assume, is your case. My opinion is that CRT may be a reasonable approach for your condition, at this time. I hope I was helpful with my answer. Feel free to ask again. Take care. Regards, Dr. Meriton