Recommendations for CHD

COR	LOE	Recommendations	References
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.	400–408
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.	409
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.	400,402,410,411
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.	400–408,412–415
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.	416–418
2b	C-LD	6. In patients with CCTGA and AV block in whom anatomic repair has not been performed, CSP with HBP or LBBAP may be considered to improve functional status.	419,420