14
Indications for CPP in Patients with HF
LBBB, sinus rhythm, QRS duration ≥ 150 ms, NYHA class
I–IV symptoms
COR LOE Recommendations
1 A 1. In patients with LVEF ≤35%, sinus rhythm, LBBB with
QRS duration ≥150 ms, and NYHA class II–IV symptoms
on GDMT, CRT with BiV pacing is indicated to improve
symptoms and reduce morbidity and mortality.
2a C-LD 2. In patients with LVEF ≤35%, sinus rhythm, LBBB with QRS
duration ≥150 ms, and NYHA class II–IV symptoms on
GDMT, CSP with HBP with left bundle branch (LBBB)
correction or LBBAP is reasonable if effective CRT cannot be
achieved with BiV pacing based on anatomical or functional
criteria.
2b B-R 3. In patients with LVEF ≤30%, sinus rhythm, LBBB, QRS
duration ≥150 ms and NYHA class I symptoms on GDMT,
CRT with BiV pacing may be considered to reduce the risk of
worsening HF and potentially improve LV remodeling.
2b C-LD 4. In patients with LVEF 36%–50%, sinus rhythm, LBBB with
QRS duration ≥150 ms, and NYHA class II–IV symptoms
on GDMT, CPP may be considered to maintain or improve
LVEF.
2b C-LD 5. In patients with LVEF ≤35%, sinus rhythm, LBBB with QRS
duration ≥150 ms, and NYHA class II–IV symptoms on
GDMT, CSP with HBP or LBBAP may be considered as an
alternative to CRT with BiV pacing.
LBBB, sinus rhythm, QRS duration 120–149 ms, NYHA class
II–IV symptoms
COR LOE Recommendations
1 A 1. In patients with select characteristics (eg, female sex) who
have LVEF ≤35%, sinus rhythm, LBBB with QRS duration
120–149 ms, and NYHA class II–IV symptoms on GDMT,
CRT with BiV pacing is recommended to reduce mortality
and HF events and to improve LVEF.
2a B-R 2. In patients who have LVEF ≤35%, sinus rhythm, LBBB
with QRS duration 120–149 ms, and NYHA class II–IV
symptoms on GDMT, CRT with BiV pacing is reasonable to
reduce mortality and HF and to improve LVEF.
