37
Colors correspond to the Class of Recommendation on pages 46 and 47.
Unfavorable response to
CRT with BiV pacing
Generator change
Continue to optimize medical
and device therapies
(1, C-LD)
Continue CRT with BiV pacing in patients
with heart failure with improved ejection
fraction (HFimpEF) at time of
elective replacement
(1, C-LD)
Chest X-ray (posterior-
anterior [PA], lateral) to
assess LV lead position
(1, C-LD)
Continue CRT with BiV pacing in patients
thought to have benefited from CRT at
time of elective replacement
(1, C-EO)
LV pacing less than optimal:
Ablation or pharmacological
suppression of frequent
premature ventricular
contractions (PVCs) or better
rhythm or rate control of AF
(2a, C-LD)
Shared decision-making: At the time of
elective replacement, consider whether
to replace cardiac resynchronization
therapy-defibrillator (CRT-D) or revise
to cardiac resynchronization therapy-
pacemaker (CRT-P)
(1, B-NR)
Suboptimal response to
CRT with BiV pacing
Crossover to CSP with
HBP or LBBAP
(2a, C-LD)
Crossover to surgical
epicardial lead implantation
(2a, B-NR)
Shared decision-making: When high lead
pacing threshold contributes to rapid
battery drain, consider implantation of a
new lead to reduce risks associated with
frequent generator replacements
(2b, C-EO)
Time
