| Patient selection |
|---|
| Recommended |
| NYHA II, III, or ambulatory IV, HF, LVEF ≤35%, QRS ≥130 ms if LBBB; sinus rhythm, and the absence of severe CKD (creatinine < 200 mmol/L or GFR > 30 mL/min/m2) |
| For consideration |
| QRS > 150 ms if non-LBBB; presence of AF; elderly age; evidence of frailty; chronic RV pacing with LVEF ≤45% |
| Imaging |
| Recommended |
| Evaluation of LVEF: echocardiogram, nuclear imaging, cardiac magnetic resonance |
| For consideration |
| Imaging for assistance in LV lead placement |
| Anticoagulation |
| Recommended |
| Continue warfarin if high risk for thromboembolism |
| For consideration |
| Novel oral anticoagulants will need to be considered on an individual basis (see text) |
| Renal insufficiency |
| Recommended |
| Adequate hydration; hold or decrease diuretics |
| For consideration |
| – |
AF, atrial fibrillation; CKD, chronic kidney disease; CRT, cardiac resynchronization therapy; GFR, glomerular filtration rate; HF, heart failure; LBBB, left bundle branch block; LV, left ventricular; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; RV, right ventricular.