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Replacement or upgrade considerations
COR LOE Recommendations
1 C-LD 1. In patients with HFimpEF, continuation of CRT with BiV
pacing is recommended at the time of elective generator
replacement.
1 C-EO 2. In patients who are thought to have benefited from CRT
(including improvement, stabilization, or partial reversal of
natural decline) in terms of symptoms, LVEF, or functional
status, continuation of CRT with BiV pacing is recommended
at the time of elective replacement based on patient-
individualized risks and benefits of the procedure.
1 B-NR 3. In patients with CRT-D at the time of elective replacement,
it is recommended that a decision for replacement vs revision
to CRT-P should be based on patient-individualized risks
and benefits of the procedure, and such shared decision-
making should involve consideration of the previous response
to CRT, appropriate implantable cardioverter-defibrillator
(ICD) therapies for ventricular arrhythmias, continued risk of
ventricular arrhythmias, inappropriate therapies, current lead
performance factors, and the patient's overall goals of care.
2b C-EO 4. In patients with CRT or CSP where high lead pacing
threshold contributes to rapid battery drain, implantation of a
new lead may be considered after shared decision-making with
the patient at the time of generator replacement to reduce the
risk associated with frequent generator replacements.
Troubleshooting for unfavorable response
COR LOE Recommendations
1 C-LD 1. In patients with HFrEF with an unfavorable response
to CRT with BiV pacing, continued efforts to optimize
medical and device therapies are recommended to improve
quality of life and long-term outcomes.
1 C-LD 2. In patients with an unfavorable response to CRT with BiV
pacing, obtaining a posteroanterior and lateral chest X-ray
is recommended to assess the LV lead position.
2a C-LD 3. In patients with an unfavorable response to CRT with BiV
pacing and who have less than optimal LV pacing percentage,
ablation or pharmacological suppression of frequent PVCs
or better rhythm or rate control of AF is reasonable to
improve cardiac function and patient symptoms.
CPP Follow-up and Management
