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Congenital Heart Disease
CHD
COR LOE Recommendations
2a C-LD 1. In patients with CHD on GDMT with a systemic LV, LVEF
<45%, and ventricular dyssynchrony (as defined by a QRS
duration z score of ≥3 or ventricular pacing ≥40%), CRT with
BiV pacing is reasonable to reduce the risk of mortality or
need for transplant.
2a C-LD 2. In patients with CHD and a systemic single ventricle who
require pacing, apical pacing is reasonable in preference to
nonapical pacing.
2b C-LD 3. In patients with CHD and a systemic single ventricle with
symptomatic HF on GDMT, CRT with multisite ventricular
pacing may be considered to maintain functional class or
ventricular function.
2b C-LD 4. In patients with CHD and a systemic RV with symptomatic
HF on GDMT associated with ventricular electrical delay
or requiring substantial ventricular pacing, CRT with BiV
pacing may be considered to improve or maintain functional
class or ventricular function.
2b C-LD 5. In patients with CHD and a subpulmonary RV with RV
dysfunction and RBBB, CRT with fusion-based pacing may
be considered to improve RV function.
2b C-LD 6. In patients with congenitally corrected transposition of the
great arteries (CCTGA) and AV block in whom anatomic
repair has not been performed, CSP with HBP or LBBAP
may be considered to improve functional status.
When to crossover to CSP, CRT, or epicardial options
COR LOE Recommendation
2a C-LD
(HBP,
LBBAP)
1. In patients with suboptimal response to CRT with BiV
pacing, CSP with HBP or LBBAP, or surgical epicardial
lead implantation can be useful when other approaches
have been unsuccessful or not feasible.
B-NR
(Surgical
Epicardial
Lead)
