Heart failure
CRT and CRT-D: cardiac resynchronisation
Follows the ESC pathway for cardiac resynchronisation therapy: HFrEF with LVEF ≤ 35%, up-titrate FMT for at least 3 months, then class by QRS duration (≥ 150, 130–149, < 130 ms) and morphology (LBBB or not), with permanent AF, high-degree AV block and upgrade from RV pacing handled separately. It then decides between CRT-P and CRT-D from the ICD indication (secondary prevention, ischaemic or non-ischaemic aetiology), life expectancy and factors that favour CRT-P. ACC/AHA classes are shown alongside.
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LV function and ECG
LVEF after ≥ 3 months of optimised FMT
NYHA class
Defibrillator (CRT-D vs CRT-P)
Cardiac resynchronisation therapy
Enter LVEF, QRS duration and morphology.
References
- Køber L, Adamo M, et al. 2026 ESC Guidelines for the management of heart failure. Eur Heart J 2026.
- Heidenreich PA, et al. 2022 AHA/ACC/HFSA Guideline for the management of heart failure. Circulation 2022;145:e895-e1032.
- Glikson M, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021;42:3427-3520.
- Zeppenfeld K, et al. 2022 ESC Guidelines for ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022;43:3997-4126.
- Cleland JGF, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure (CARE-HF). N Engl J Med 2005;352:1539-1549.
- Bristow MR, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure (COMPANION). N Engl J Med 2004;350:2140-2150.
- Køber L, et al. Defibrillator implantation in patients with nonischemic systolic heart failure (DANISH). N Engl J Med 2016;375:1221-1230.