[Left ventricular electrode placement in cardiac resynchronization therapy].

Abstract

Cardiac resynchronization therapy (CRT) is an important component of the treatment of heart failure patients with reduced left ventricular (LV) ejection fraction and a widened ventricular complex due to bundle branch block. The positioning of the LV lead, which is placed in lateral branches of the coronary sinus (CS), is of particular importance, as optimal positioning is crucial for the success of therapy; poor or incorrect positioning can worsen the prognosis. CS cannulation and LV lead implantation is particularly challenging when learning the procedure, and overall, has a flatter learning curve compared to the implantation of a dual-chamber device. Therefore, in addition to theoretical knowledge, surgical experience and manual dexterity are also important. This article is intended to provide the reader a comprehensive understanding of the fundamental principles of implantation. Techniques for cannulation of challenging CS anatomies are presented, and routinely encountered difficulties such as venous valves and common complications are described using examples. Additionally, we will describe the different types of leads and their respective benefits and disadvantages. We hope to provide tips and tricks to facilitate the swift and successful application of CRT therapy in daily practice.