Would a patient with severe LV dysfunction and LBBB but only Class I symptoms benefit from a BiV upgrade?
I generally think about BiV pacing in patients with symptomatic heart failure and patients with a high percentage of v-pacing - and lately, some patients with MR. I wasn't sure what the data was for Class I HF patients, so I went back to the Block-HF trial and learned that actually 10-15% of these patients were NYHA Class I. It's hard to be sure that the overall trial results hold true for this specific subgroup, and my clinical experience has been that EP gets variably excited about these patients, but I certainly think this data supports the ask.
Curtis AB, Worley SJ, Adamson PB, et al. Biventricular Pacing for Atrioventricular Block and Systolic Dysfunction. New England Journal of Medicine. 2013;368(17):1585-1593. doi:https://doi.org/10.1056/nejmoa1210356
