Treatment
Device Therapy for Stage C HFr EF (see Table 18)
ÎÎICD therapy is recommended for primary prevention of sudden
cardiac death (SCD) to reduce total mortality in selected patients with
nonischemic DCM or ischemic heart disease at least 40 days post-MI
with LVEF of 35% or less and NYHA class II or III symptoms on chronic
GDMT, who have a reasonable expectation of meaningful survival for
more than 1 year.a (I-A)
ÎÎCardiac resynchronization therapy (CRT) is indicated for patients who
have LVEF of 35% or less, sinus rhythm, left bundle-branch block
(LBBB) with a QRS duration of 150 ms or greater, and NYHA class II,
III, or ambulatory class IV symptoms on GDMT. (I-A for NYHA class III/
IV; I-B for NYHA class II)
ÎÎICD therapy is recommended for primary prevention of SCD to reduce
total mortality in selected patients at least 40 days post-MI with LVEF
of 30% or less and NYHA class I symptoms while receiving GDMT, who
have a reasonable expectation of meaningful survival for more than 1
year.a (I-B)
ÎÎCRT can be useful for patients who have LVEF of 35% or less, sinus
rhythm, a non-LBBB pattern with a QRS duration of 150 ms or greater,
and NYHA class III/ambulatory class IV symptoms on GDMT. (IIa-A)
ÎÎCRT can be useful for patients who have LVEF of 35% or less, sinus
rhythm, LBBB with a QRS duration of 120–149 ms, and NYHA class II,
III, or ambulatory class IV symptoms on GDMT. (IIa-B)
ÎÎCRT can be useful in patients with AF and LVEF of 35% or less on
GDMT if a) the patient requires ventricular pacing or otherwise meets
CRT criteria and b) atrioventricular nodal ablation or pharmacological
rate control will allow near 100% ventricular pacing with CRT. (IIa-B)
ÎÎCRT can be useful for patients on GDMT who have LVEF of 35% or less
and are undergoing placement of a new or replacement device with
anticipated requirement for significant (>40%) ventricular pacing.
(IIa-C)
ÎÎThe usefulness of implantation of an ICD is of uncertain benefit to
prolong meaningful survival in patients with a high risk of nonsudden
death as predicted by frequent hospitalizations, advanced frailty,
or comorbidities such as systemic malignancy or severe renal
dysfunction.a (IIb-B)
ÎÎCRT may be considered for patients who have LVEF of 35% or less,
sinus rhythm, a non-LBBB pattern with a QRS duration of 120–149 ms,
and NYHA class III/ambulatory class IV on GDMT. (IIb-B)
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