April 3, 2022Open Access
View Full PaperTroubleshooting the difficult left ventricular lead placement in cardiac resynchronization therapy: current status and future perspectives
Key Result
Interventional CRT techniques utilizing dedicated inner catheters and direct venography may simplify left ventricular lead placement compared to traditional over-the-wire techniques.
Structured PICO
Do Interventional CRT (I-CRT) techniques improve the success and ease of left ventricular lead placement compared to traditional over-the-wire techniques in patients undergoing CRT?
P
Population
Patients undergoing cardiac resynchronization therapy (CRT) requiring left ventricular lead placement
I
Intervention
Interventional CRT (I-CRT) techniques, including dedicated inner catheters, guidewires, and direct venography
C
Comparator
Traditional over-the-wire technique
O
Outcome
Successful left ventricular lead placement and overcoming common implantation problems
Interventional CRT (I-CRT) techniques offer specialized tools and better support to overcome challenges in difficult left ventricular lead placement during CRT implantation.
Abstract
INTRODUCTION: Cardiac resynchronization therapy (CRT) is an important option in modern cardiac implantable electronic device (CIED) treatment. Techniques for left ventricular (LV) lead placement in the coronary sinus and its tributaries are neither well described nor studied systematically, despite attention regarding where to place the LV lead. AREAS COVERED: This review presents specialized tools and techniques to overcome some of the most common problems encountered in LV lead placement in CRT. These tools and techniques are termed Interventional CRT (I-CRT), as they share technology with other interventional procedures. The main principle in I-CRT, compared to the traditional over-the-wire technique, is to add better support for delivery of the LV lead through dedicated inner catheters that also allows more flexibility with the use of more guidewires and better imaging with direct venography in the target vein. EXPERT OPINION: Even though CRT is an established therapeutic option, there are still many challenges in the implementation of the therapy. The cornerstone should be an ease of delivering the CRT and specifically implantation of the LV lead. Therefore, knowledge of the principles in I-CRT is necessary, as I-CRT could make implantation simpler in general and easier to reach the optimal LV pacing site.