How would you choose between left bundle pacing and CRT-P in a patient with a new high-degree AV block and pre-existing reduced LVEF, who does not otherwise meet the criteria for CRT-D?

This is a unique population described in the 2018 ACC AHA HRS Bradycardia guidelines - defined as LVEF 35-50% with >40% pacing, essentially what's left when you subtract the 2013 NEJM BLOCK HF trial = LVEF <50% minus all the SCD-HeFT LVEF <35% on GDMT and a small population of MUSTT LVEF <40% inducible VT patients getting ICDs. The guideline carries an IIa indication for physiologic ventricular activation (CRT, His bundle) over RV pacing. In the 2022 ACC AHA HFSA Heart Failure guidelines, section 7.4.2 regarding Other Implantable Electrical Interventions it comments "His bundle and left bundle pacing are attractive because they use the intrinsic conduction system. In observational data, there does appear to benefit over RV pacing; however, ...