Abstract
Cardiac resynchronization therapy (CRT) is a mainstay in the management of heart failure patients with electrical dyssynchrony. Left ventricular (LV) lead positioning remains an important variable that predicts the response to CRT. Anatomical and technical challenges can hinder optimal LV lead placement using traditional lead implantation approaches. Knowledge of normal anatomical variants and common anomalies is essential for successful LV lead implants. With advancements in tools and techniques for LV lead delivery, the implanting electrophysiologist can target the optimal LV pacing site, rather than accepting a suboptimal location that is less likely to provide clinical benefit. In this review, we discuss various challenges to achieving optimal LV lead implantation and present strategies to overcome them.
Highlights
Cardiac resynchronization therapy (CRT) is a well-established treatment strategy for patients with heart failure with reduced ejection fraction and evidence of interventricular dyssynchrony.[1]
With the advancements made in tools and techniques for left ventricular (LV) lead delivery, the implanting electrophysiologist has a variety of approaches to adopt when encountering challenging LV lead implants to obtain the maximal clinical benefit
CRT is a mainstay in the management of heart failure patients with electrical dyssynchrony
Summary
Cardiac resynchronization therapy (CRT) is a well-established treatment strategy for patients with heart failure with reduced ejection fraction and evidence of interventricular dyssynchrony.[1] An essential component of optimal CRT delivery is the placement of a left ventricular (LV) pacing lead through the epicardial venous system to recruit areas of delayed myocardial activation and restore synchrony. Despite preclinical and clinical studies supporting that CRT provides hemodynamic and clinical benefits, a significant proportion of patients receiving CRT remain nonresponders.[2,3] Among factors responsible for CRT nonresponse, suboptimal LV lead positioning represents an important technical component.[4] Anatomical limitations imposed by the coronary venous system pose significant challenges to optimal LV lead positioning. We discuss various challenges to achieving optimal LV lead implantation and explain strategies to overcome them
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