16
Non-LBBB, sinus rhythm, QRS duration ≥ 150 ms, NYHA class
II–IV symptoms
COR LOE Recommendations
2a A 1. In patients who have LVEF ≤35%, sinus rhythm, a non-
LBBB pattern with QRS duration ≥150 ms, and NYHA
class III or ambulatory class IV symptoms on GDMT, CRT
with BiV pacing can be useful to improve functional class,
cardiac structure, and LVEF.
2b B-R
(CRT)
2. In patients who have LVEF ≤35%, sinus rhythm, a non-
LBBB pattern with QRS duration ≥ 150 ms, and NYHA
class II symptoms on GDMT, CPP may be considered to
potentially improve mortality, heart failure hospitalization
(HFH), LVEF, and/or functional class.
C-LD
(HBP,
LBBAP)
2b C-LD 3. In patients with LVEF ≤35%, sinus rhythm, non-LBBB with
QRS duration ≥150 ms, and NYHA class II–IV symptoms
on GDMT, CSP with HBP or LBBAP may be reasonable if
effective CRT cannot be achieved with BiV pacing based on
anatomical or functional criteria.
Non-LBBB, QRS duration <150 ms, NYHA class I–IV
symptoms
COR LOE Recommendations
2b B-NR
(CRT)
1. In patients who have LVEF ≤35%, sinus rhythm, a non-
LBBB pattern with QRS duration 120–149 ms, and NYHA
class III or IV symptoms on GDMT, the usefulness of CPP is
not well established.
C-LD
(HBP,
LBBAP)
3: No
Benefit
B-R 2. In patients with LVEF ≤35%, NYHA class II to IV
symptoms on GDMT, and QRS duration <120 ms, CRT
with BiV pacing is not recommended.
3: No
Benefit
B-R 3. In patients who have LVEF ≤35%, sinus rhythm, a non-
LBBB pattern with a QRS duration <150 ms, and NYHA
class I or II symptoms on GDMT, CRT with BiV pacing is
not recommended.
Indications for CPP in Patients with HF
