2012 ACCF/AHA/HRS Focused Update of the 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

Perspective:

The following are 10 new or modified recommendations for device therapy:

1. Cardiac resynchronization therapy (CRT) is indicated for patients with an ejection fraction (EF) ≤35%, sinus rhythm, left bundle branch block (LBBB), QRS ≥150 ms, and New York Heart Association (NYHA) class II-IV symptoms.

2. CRT is reasonable for patients with an EF ≤35%, sinus rhythm, left bundle branch block (LBBB), QRS 120-149 ms, and NYHA class II-IV symptoms.

3. CRT is reasonable for patients with an ejection fraction (EF) ≤35%, sinus rhythm, non-LBBB pattern, QRS ≥150 ms, and New York Heart Association (NYHA) class III-IV symptoms.

4. CRT is reasonable for patients with an EF ≤35% and atrial fibrillation if the patient requires ventricular pacing or otherwise meets CRT criteria.

5. CRT is reasonable for patients with an EF ≤35% who are undergoing device placement and will need >40% ventricular pacing.

6. CRT may be considered for patients with an EF ≤30%, ischemic cardiomyopathy, sinus rhythm, LBBB, QRS ≥150 ms, and NYHA class I symptoms.

7. CRT may be considered for patients with an EF ≤30%, sinus rhythm, a non-LBBB pattern, QRS 120-149 ms, and NYHA class III-IV symptoms.

8. CRT may be considered for patients with an EF ≤30%, sinus rhythm, a non-LBBB pattern, QRS ≥150 ms, and NYHA class II symptoms.

9. CRT is not recommended for patients with NYHA class I-II symptoms, a non-LBBB pattern, and a QRS <150 ms.

10. CRT is not indicated for patients whose prognosis for survival with good functional capacity is limited to <1 year.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Implantable Devices, EP Basic Science, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, Acute Heart Failure

Keywords: Heart Diseases, Myocardial Ischemia, Nephrotic Syndrome, Heart Defects, Congenital, Cardiac Pacing, Artificial, Heart Failure, Bundle-Branch Block, Hospitals, Teaching, Cardiac Resynchronization Therapy


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