30
Treatment
Device Therapy for Stage C HFr EF (see Table 20)
Î ICD 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 ≥40 days post-MI with
LVEF of ≤35% and NYHA class II or III symptoms on chronic GDMT,
who have a reasonable expectation of meaningful survival for >1 year.
a
(I-A)
Î Cardiac 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)
Î ICD 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)
Î CRT can be useful for patients who have LVEF of ≤35% , sinus rhythm,
a non-LBBB pattern with a QRS duration of ≥150 ms, and NYHA class
III/ambulatory class IV symptoms on GDMT. (IIa-A)
Î CRT can be useful for patients who have LVEF of ≤35%, 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)
Î CRT can be useful in patients with AF and LVEF of ≤35% 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)
Î CRT can be useful for patients on GDMT who have LVEF of ≤35%
and are undergoing placement of a new or replacement device with
anticipated requirement for significant (>40%) ventricular pacing.
(IIa-C)
Î The 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)
Î CRT may be considered for patients who have LVEF of ≤35%, 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)
