Effect of ventricular leads position on the clinic outcome of cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure patients with severely obvious left ventricular ejection fraction (LVEF) and evidence of cardiac dyssynchrony.1-3 With conventional biventricular stimulation,notable left ventricular (LV) reverse remodeling,the most reliable predictor of long-term survival in CRT patients,is achieved in only 60% -70% of the patients.4,5 Lack of LV dyssynchrony,non-optimal position of the LV pacing lead,high-myocardial scar burden,and sub-optimal device programming have been related to non-response to CRT.6-8 Particularly,the optimal placement of LV lead in a tributary of the coronary sinus is one of the most challenging technique of CRT device implantation.This article will discuss the effect of ventricular leads on the clinic outcome after CRT and how to locate the optimal ventricular leads to maximize the haemodynamic benefits of CRT and provide superior longterm outcome.