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Importance of Right Ventricular and Left Ventricular Lead Placement in Cardiac Resynchronisation Therapy

  • Radu Ciudin
  • Leonard Alexandru Mandes
Chapter

Abstract

Cardiac resynchronisation therapy was a major advancement in the treatment of patients with heart failure, improving both the symptoms and left ventricular ejection fraction while reducing left ventricular volumes and increasing survival. Nevertheless, in spite of all the advancements in the technique and the numerous studies aimed at choosing the suitable candidates for device implantation or the optimal site for lead placement, some important questions still remain unanswered since a relatively large number of patients fail to have an adequate response to left ventricular pacing (Zareba and Klein, Circulation 123:1061–72, 2011; Daubert et al., Europace 14(9):1236–86, 2012). Therefore, having a better insight on the means to achieve the optimal technique and the different approaches suitable for selected, difficult cases might help in increasing the number of adequate responders. Beside optimal patient selection, choosing an appropriate site for right and left ventricular lead placement is paramount for a successful resynchronisation. Numerous studies advocate for targeted left ventricular lead placement, by using either radiological markers, electrical parameters or multimodality imaging aimed at finding the latest viable activated left ventricular wall segment (Mortensen et al., Europace 12(12):1750–6, 2010; Zhou et al., JACC Cardiovasc Imaging 7(12):1239–48, 2014). Moreover, when the conventional approach for pacing in the left ventricle fails, other techniques might prove to be the right solution, such as endocardial/epicardial (by surgery) methods or leadless pacing (DeRose et al., J Am Coll Cardiol 41:1414–9, 2003; Garrigue et al., Am J Cardiol 88:858–62, 2001; Auricchio et al., Europace 16(5):681–8, 2014; Neuzil et al., Europace 16(Suppl. 2):35, 2014). Finally, other studies affirm that the right ventricular lead position has an important influence over the success of resynchronisation (Merchant et al., Pacing Clin Electrophysiol 33:575–82, 2010; Heist et al., Am J Cardiol 96:685–90, 2005).

Keywords

Cardiac resynchronisation therapy Lead placement Pacing site LV dysfunction Electrical dyssynchrony 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Radu Ciudin
    • 1
    • 2
  • Leonard Alexandru Mandes
    • 2
  1. 1.“Carol Davila” University of Medicine and PharmacyBucharestRomania
  2. 2.Cardiology Department“Prof. C.C. Iliescu” Emergency Institute for Cardiovascular DiseasesBucharestRomania

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