����CRT may be considered for patients who have:
������ LVEF ���30%, ischemic etiology of HF, sinus rhythm, LBBB with a QRS duration
���150 ms, and NYHA class I symptoms on GDMT. (IIb-C)
������ LVEF ���35%, sinus rhythm, a non-LBBB pattern with a QRS duration 120-149
ms, and NYHA class III/ambulatory class IV on GDMT. (IIb-B)
������ LVEF ���35%, sinus rhythm, a non-LBBB pattern with a QRS duration ���150 ms,
and NYHA class II symptoms on GDMT. (IIb-B)
����CRT is NOT recommended for patients:
������ with NYHA class I or II symptoms and non-LBBB pattern with QRS duration ���
<150 ms. (III-B: No Benefit)
������ whose comorbidities and/or frailty limit survival with good functional capacity to
<1 year. (III-C: No Benefit)
Pacing in Patients With Hypertrophic Cardiomyopathy (HCM)
Treatment
����Permanent pacing is indicated for:
������ SND or AV block in patients with HCM as described previously (See ���Permanent
Pacing in Sinus Node Dysfunction��� and ���Acquired Atrioventricular Block in
Adults���). (I-C)
����Permanent pacing may be considered:
������ in medically refractory symptomatic patients with HCM and significant resting or
provoked LV outflow tract obstruction. (IIb-A)
As for Class I indications, when risk factors for SCD are present, consider a dual-chamber pacemaker that senses/paces in the atrium/ventricle and is inhibited/triggered by
intrinsic rhythm (DDD) ICD (���See Implantable Cardioverter-Defibrillator���).
����Permanent pacemaker implantation is NOT indicated for:
������ patients who are asymptomatic or whose symptoms are medically controlled. ���
(III -C)
������ symptomatic patients without evidence of LV outflow tract obstruction. (III-C)
Permanent Pacing in Children, Adolescents, and Patients With
Congenital Heart Disease
Key Points
����The most common indications for permanent pacemaker implantation
in children, adolescents, and patients with congenital heart disease
may be classified as:
������ symptomatic sinus bradycardia
������ the bradycardia-tachycardia syndromes
������ advanced second- or third-degree AV block, either congenital or postsurgical.
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