Table 4.
Current CRT recommendations from the 2021 ESC guideline on cardiac pacing and CRT and the 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure.
| Clinical Scenarios | 2021 ESC Guideline on Cardiac Pacing and CRT [1] | Clinical Scenarios | 2023 HRS/APHRS/LAHRS Guideline on Cardiac Physiologic Pacing [95] |
|---|---|---|---|
| HF, SR, LVEF ≤ 35%, LBBB, QRS ≥ 150 ms | BiVP-CRT (I-A) HBP if unsuccessful CS lead implantation (IIa-B) |
HF, LBBB, LVEF ≤ 30%, NYHA class I | BiVP-CRT (2b, B-R) |
| HF, SR, LVEF ≤ 35%, LBBB, QRS 130–149 ms | BiVP-CRT (IIa-B) HBP if unsuccessful CS lead implantation (IIa-B) |
HF, LBBB, QRS ≥ 150 ms, LVEF ≤ 35%, NYHA class II-IV | BiVP-CRT (1, A) HBP or LBBAP if BiVP-CRT cannot be achieved (2a, C-LD) |
| HF, SR, LVEF ≤ 35%, non-LBBB, QRS ≥ 150 ms | BiVP-CRT (IIa-B) HBP if unsuccessful CS lead implantation (IIa-B) |
HF, LBBB, QRS 120–149 ms, LVEF ≤ 35%, NYHA class II-IV | BiVP-CRT (1, A) if female sex BiVP-CRT (2a, B-R) for the rest |
| HF, SR, LVEF ≤ 35%, non-LBBB, QRS 130–149 ms | BiVP-CRT (IIb-B) HBP if unsuccessful CS lead implantation (IIa-B) |
HF, LBBB, QRS ≥ 150 ms, LVEF 36–50%, NYHA class II-IV | BiVP-CRT (2b, C-LD) HBP or LBBAP (2b, C-LD) |
| HF, AF, LVEF ≤ 35%, LBBB, QRS ≥ 130 ms, NYHA class III-IV | BiVP-CRT (IIa-C) HBP if unsuccessful CS lead implantation (IIa-B) |
HF, non-LBBB, LVEF ≤ 35%, QRS 120–149 ms, NYHA class III-IV | BiVP-CRT (2b, B-NR) HBP or LBBAP (2b, C-LD) |
| HF, LVEF ≤ 35%, previous PM/ICD with high VP burden | BiVP-CRT (IIa-B) HBP if unsuccessful CS lead implantation (IIa-B) |
HF, non-LBBB, LVEF ≤ 35%, QRS ≥ 150 ms, NYHA class II | BiVP-CRT (2b, B-R) HBP or LBBAP (2b, C-LD) |
| Symptomatic AF, LVEF < 40% candidates for AVN ablation | BiVP-CRT (I-B) HBP if unsuccessful CS lead implantation (IIa-B) HBP (IIb-C) |
HF, non-LBBB, LVEF ≤ 35%, QRS ≥ 150 ms, NYHA class III-IV | BiVP-CRT (2a, A) HBP or LBBAP if BiVP-CRT cannot be achieved (2b, C-LD) |
| Symptomatic AF, LVEF 40–49% candidates for AVN ablation | BiVP-CRT (IIa-C) HBP if unsuccessful CS lead implantation (IIa-B) HBP (IIb-C) |
Pacemaker indication, LVEF 36–50% and anticipated high VP burden | BiVP-CRT (2a, B-R) HBP or LBBAP (2a, B-NR) |
| Symptomatic AF, LVEF ≥50% candidates for AVN ablation | BiVP-CRT (IIb-C) HBP if unsuccessful CS lead implantation (IIa-B) HBP (IIb-C) |
Pacemaker indication, LVEF 36–50%, LBBB and anticipated low VP burden | BiVP-CRT (2b, C-LD) HBP or LBBAP (2b, C-LD) |
| SR or AF, pacing indication for high degree AV block and LVEF < 40% | BiVP-CRT (I-A) HBP if unsuccessful CS lead implantation (IIa-B) |
PICM with HF and high burden RVP | BiVP-CRT (1, B-NR) HBP or LBBAP (2b, C-LD) |
| AF + AVN ablation + LVEF ≤ 50% | BiVP-CRT (2a, B-R) |
AF: Atrial fibrillation; AVN: Atrioventricular node; BiVP-CRT: Biventricular pacing cardiac resynchronization therapy; HBP: His bundle pacing; HF: Heart failure: SR: Sinus rhythm; LVEF: Left ventricular ejection fraction; LBBAP: Left bundle branch area pacing; LBBB: Left bundle branch block; NYHA: New York Heart Association; PICM: Pacemaker induced cardiomyopathy; RVP: Right ventricular pacing; VP: Ventricular pacing.