ÎÎCRT may be considered for patients who have:
• LVEF ≤30%, ischemic etiology of HF, sinus rhythm, LBBB with a QRS duration
≥150 ms, and NYHA class I symptoms on GDMT. (IIb-C)
• LVEF ≤35%, sinus rhythm, a non-LBBB pattern with a QRS duration 120-149
ms, and NYHA class III/ambulatory class IV on GDMT. (IIb-B)
• LVEF ≤35%, sinus rhythm, a non-LBBB pattern with a QRS duration ≥150 ms,
and NYHA class II symptoms on GDMT. (IIb-B)
ÎÎCRT is NOT recommended for patients:
• with NYHA class I or II symptoms and non-LBBB pattern with QRS duration
<150 ms. (III-B: No Benefit)
• whose comorbidities and/or frailty limit survival with good functional capacity to
<1 year. (III-C: No Benefit)
Pacing in Patients With Hypertrophic Cardiomyopathy (HCM)
Treatment
ÎÎPermanent pacing is indicated for:
• SND or AV block in patients with HCM as described previously (See "Permanent
Pacing in Sinus Node Dysfunction" and "Acquired Atrioventricular Block in
Adults"). (I-C)
ÎÎPermanent pacing may be considered:
• in medically refractory symptomatic patients with HCM and significant resting or
provoked LV outflow tract obstruction. (IIb-A)
As for Class I indications, when risk factors for SCD are present, consider a dual-chamber pacemaker that senses/paces in the atrium/ventricle and is inhibited/triggered by
intrinsic rhythm (DDD) ICD ("See Implantable Cardioverter-Defibrillator").
ÎÎPermanent pacemaker implantation is NOT indicated for:
• patients who are asymptomatic or whose symptoms are medically controlled.
(III -C)
• symptomatic patients without evidence of LV outflow tract obstruction. (III-C)
Permanent Pacing in Children, Adolescents, and Patients With
Congenital Heart Disease
Key Points
ÎÎThe most common indications for permanent pacemaker implantation
in children, adolescents, and patients with congenital heart disease
may be classified as:
• symptomatic sinus bradycardia
• the bradycardia-tachycardia syndromes
• advanced second- or third-degree AV block, either congenital or postsurgical.
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