Abstract
Introduction: Cardiac resynchronization therapy (CRT) can markedly improve heart failure treatment in selected patients, but left ventricular (LV) lead implantation can be difficult or optimal lead position not obtainable. Methods: This review examines newer techniques and technologies to optimize implant success. Goals of implant include placement of the LV lead in a coronary vein near the midlateral left ventricle with good lead stability, adequate thresholds, and no phrenic nerve stimulation. We will examine methods to access difficult and tortuous veins, test multiple veins for the best pacing site, and avoid complications. Newer technologies that will be discussed include magnetic wire navigation using Stereotaxis™, endoscopic, and CT‐guided approaches, and nontraditional methods such as pericardial puncture for epicardial LV lead placement. Conclusion: The methods discussed here may help to make CRT implant safer, faster, and more successful.
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