Cardiac resynchronization therapy lead placement

Fig. 4.88 A. Guide wire passed into a posterolateral branch of the CS. B. Example of the various angioplasty guide wires for use in over the wire lead placement (from Belott PH Implantation Techniques for Cardiac resynchronization Therapy Barold SS, Mugica J Fifth Decade of Cardiac Pacing. Armonk NY Futura. 2004 pp 18)...

Dekker AL, Phelps B, Dijkman B, van der Nagel T, van der Veen FH, Geskes GG, Maessen JG. Epicardial left ventricular lead placement for cardiac resynchronization therapy optimal pace site selection with pressure-volume loops. J Thorac Cardiovasc Surg 2004 127 1641-7. 

Koos R, Sinha AM, Markus K, Breithardt OA, Mischke K, Zarse M, Schmid M, Autschbach R, Hanrath P, Stellbrink C. Comparison of left ventricular lead placement via the coronary venous approach versus lateral thoracotomy in patients receiving cardiac resynchronization therapy. Am J Cardiol 2004 94 59-63. 

CRT reduces symptoms of CHF and improves cardiac performance in patients with moderate-to-severely symptomatic heart failure, severe left ventricular systolic dysfunction, normal sinus rhythm and a wide QRS complex. Resynchronization therapy significantly reduces hospitalizations in these patients and is highly cost-effective. Perhaps most important, resynchronization therapy for heart failure improves survival for these patients, particularly when employed in conjunction with an implantable defibrillator. However, randomized clinical trials show that a substantial minority of patients are clinical nonresponders. Therefore, critical questions remain with respect to identifying appropriate candidates for CRT, optimal device programming, and left ventricular lead placement. 

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