Lead positioning for cardiac resynchronization therapy: techniques and priorities
Lead positioning for cardiac resynchronization therapy: techniques and priorities
Although cardiac resynchronization therapy (CRT) has demonstrated to be an effective treatment for heart failure patients, up to 30–40% of the patients do not show a favourable response. Implantation of the left ventricular (LV) pacing lead is one of the determinants of CRT response.
This procedure includes several challenging technical issues and strongly depends on the highly variable anatomy of the coronary sinus and tributaries. In addition, the final position of the LV pacing lead may target the latest activated areas of the left ventricle in order to obtain effective resynchronization. Furthermore, the presence of transmural myocardial scar at the region targeted by the LV lead may also determine the response to CRT. This review discusses all the issues related to LV lead implantation and the role of multimodality imaging to anticipate the implantation strategy. Finally, alternative LV pacing sites and their effect on clinical outcome and LV performance will be discussed.
cardiac resynchronization therapy, pacing, endocardial, epicardial, coronary sinus
v22-v28
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680
Delgado, Victoria
e2a70054-f6ad-414f-8e5e-a4c79342b25a
2009
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680
Delgado, Victoria
e2a70054-f6ad-414f-8e5e-a4c79342b25a
Morgan, John M. and Delgado, Victoria
(2009)
Lead positioning for cardiac resynchronization therapy: techniques and priorities.
Europace, 11, supplement 5, .
(doi:10.1093/europace/eup306).
Abstract
Although cardiac resynchronization therapy (CRT) has demonstrated to be an effective treatment for heart failure patients, up to 30–40% of the patients do not show a favourable response. Implantation of the left ventricular (LV) pacing lead is one of the determinants of CRT response.
This procedure includes several challenging technical issues and strongly depends on the highly variable anatomy of the coronary sinus and tributaries. In addition, the final position of the LV pacing lead may target the latest activated areas of the left ventricle in order to obtain effective resynchronization. Furthermore, the presence of transmural myocardial scar at the region targeted by the LV lead may also determine the response to CRT. This review discusses all the issues related to LV lead implantation and the role of multimodality imaging to anticipate the implantation strategy. Finally, alternative LV pacing sites and their effect on clinical outcome and LV performance will be discussed.
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Published date: 2009
Keywords:
cardiac resynchronization therapy, pacing, endocardial, epicardial, coronary sinus
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Local EPrints ID: 151085
URI: http://eprints.soton.ac.uk/id/eprint/151085
ISSN: 1099-5129
PURE UUID: 1a2e01a7-b1c6-4755-b68a-791a08a80739
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Date deposited: 07 May 2010 15:30
Last modified: 14 Mar 2024 01:19
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Author:
John M. Morgan
Author:
Victoria Delgado
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