Decorative image

Heart Failure Management

Indications and Guidelines

Recommendation for Cardiac Resynchronization Therapy in patients with severe systolic heart failure. Download guidelines (PDF, 182 KB).

Expand All

Class I Recommendations

Class I Recommendations

CRT with or without ICD therapy is indicated for the treatment of heart failure in patients with*:

  • NYHA Functional Class III or ambulatory Class IV heart failure symptoms
  • LVEF ≤ 35%
  • QRS duration ≥ 120 ms
  • Sinus rhythm
  • Optimal recommended medical therapy

(Level of Evidence: A)

ICD therapy is indicated in patients*:
Level of Evidence: A

  • With LVEF ≤ 35% due to prior MI who are at least 40 days post-MI and are in NYHA Functional Class II or III
  • With LV dysfunction due to prior MI who are at least 40 days post-MI, have an LVEF ≤ 30%, and are in NYHA Functional Class I
  • Who are survivors of cardiac arrest due to VF or hemodynamically unstable sustained VT after evaluation to define the cause of the event and to exclude any completely reversible causes

* Assuming patients are on chronic, optimal medical therapy and have a reasonable expectation of survival with good functional status for > 1 year.



Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation. May 27, 2008;117(21):e350-408.

Class IIa Recommendations