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Lead positioning strategies to enhance response to cardiac resynchronization therapy

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Abstract

Left ventricular lead position is one of the main determinants of CRT response. There are several approaches in LV lead positioning that include favoring an optimal anatomical position or targeting either the segment with maximal mechanical dyssynchrony or a region with maximal electrical delay. The conventional LV lead implantation faces several technical difficulties that may prevent the obtaining of a stable position and good performance of the LV lead without phrenic nerve stimulation. In addition, implant of the LV pacing lead in areas with myocardial scar may result in less than optimal cardiac resynchronization. Several strategies have been proposed to overcome all these obstacles including multimodality cardiac imaging to help in preprocedural or intraprocedural identification of the latest activated areas of the LV and the potential anatomical constraints. In selected patients, the surgical implant may be a solution to overcome these constraints. In the future, LV endocardial or epicardial multisite pacing may deliver an enhanced response to CRT.

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Acknowledgments

This work was performed during Dr. Dan Blendea’s tenure as the Michel Mirowski Fellow in Cardiac Pacing and Electrophysiology of the Heart Rhythm Society.

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  1. Cardiac Arrhythmia Service, Massachusetts General Hospital Heart Center, Harvard Medical School, Boston, MA, USA

    Dan Blendea & Jagmeet P. Singh

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  1. Dan Blendea
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Correspondence to Jagmeet P. Singh.

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Blendea, D., Singh, J.P. Lead positioning strategies to enhance response to cardiac resynchronization therapy. Heart Fail Rev 16, 291–303 (2011). https://doi.org/10.1007/s10741-010-9212-4

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