38
Treatment
7.4.1. ICDs and CRTs
COR LOE
Recommendations
2a B-NR 8. For patients who have LVEF ≤35%, sinus rhythm, LBBB with
a QRS duration of 120 to 149 ms, and NYHA class II, III, or
ambulatory IV symptoms on GDMT, CRT can be useful to
reduce total mortality, reduce hospitalizations, and improve
symptoms and QOL.
2a B-NR 9. In patients with AF and LVEF ≤35% on GDMT, CRT
can be useful to reduce total mortality, improve symptoms
and QOL, and increase LVEF, if: a) the patient requires
ventricular pacing or otherwise meets CRT criteria and
b) atrioventricular nodal ablation or pharmacological rate
control will allow near 100% ventricular pacing with CRT.
2a B-NR 10. For patients on GDMT who have LVEF ≤35% and are
undergoing placement of a new or replacement device
implantation with anticipated requirement for significant
(>40%) ventricular pacing, CRT can be useful to reduce total
mortality, reduce hospitalizations, and improve symptoms
and QOL.
2a B-NR 11. In patients with genetic arrhythmogenic cardiomyopathy
with high-risk features of sudden death, with EF ≤45%,
implantation of ICD is reasonable to decrease sudden death.
2b B-NR 12. For patients who have LVEF ≤35%, sinus rhythm, a
non-LBBB pattern with QRS duration of 120 to 149 ms,
and NYHA class III or ambulatory class IV on GDMT,
CRT may be considered to reduce total mortality, reduce
hospitalizations, and improve symptoms and QOL.
2b B-NR 13. For patients who have LVEF ≤30%, ischemic cause of HF,
sinus rhythm, LBBB with a QRS duration ≥150 ms, and
NYHA class I symptoms on GDMT, CRT may be considered
to reduce hospitalizations and improve symptoms and QOL.
3: No
Benefit
B-R 14. In patients with QRS duration <120 ms, CRT is not
recommended.
3: No
Benefit
B-NR 15. For patients with NYHA class I or II symptoms and non-
LBBB pattern with QRS duration <150 ms, CRT is not
recommended.
3: No
Benefit
C-LD 16. For patients whose comorbidities or frailty limit survival
with good functional capacity to <1 year, ICD and cardiac
resynchronization therapy with defibrillation (CRT-D) are
not indicated.
(cont'd)
