4
Introduction
Other Important Considerations
1. Shared decision-making is recommended when contemplating
implantation of a CPP device and should include considerations of
the patient's values, preferences, goals of care, and prognosis, along
with the potential benefits, short- and long-term risks (in particular,
device-associated infection), effects of these pacing modalities on
battery longevity, future lead management issues, evidence base for
different types of CPP, and considerations at end of life.
2. Substantial RV pacing of ≥ 20%–40% may induce cardiomyopathy in
a subset of patients.
3. Remote monitoring and in-person echocardiographic and
electrocardiographic evaluations are essential during follow-up after
implantation of a CPP device to ensure appropriate capture and
optimization of therapy.
4. In patients with HF with improved LVEF or benefit from CRT
(including improvement, stabilization, or partial reversal of natural
decline), continuation of CRT with BiV pacing is recommended at
device replacement.
5. In patients with an unfavorable response to CRT with BiV pacing,
optimization of both medical and device therapies is recommended.
6. In selected patients with congenital heart disease (CHD) or
congenital atrioventricular block (AVB), CRT or conduction system
area pacing may be considered.
7. Long-term data on CSP are emerging, with current data derived from
observational studies or small randomized clinical trials without
long-term follow-up. Robust data from ongoing, larger randomized
trials are expected.
