Implantation of cardiac resynchronization devices

With the increasing use of cardiac resynchronization therapy (CRT) devices, cardiologists from varying backgrounds, including electrophysiology, interventional cardiology, and congestive heart failure specialties, require a working knowledge of the issues involved in implanting left ventricular (LV) pacing leads as part of cardiac resynchronization therapy (CRT).^1-3 Over the last few years, it has become increasingly clear not only that one needs to access the coronary venous system, but also that familiarity with navigating within this system to reach optimal pacing sites is required.^4,5 In this chapter, we will review the technical aspects of placing left ventricular (LV) pacing leads. A brief discussion of relevant gross and fluoroscopic anatomy is followed by a description of commonly encountered problems, with suggested solutions for each step of the LV lead implantation process. Since this is a significantly invasive cardiac procedure, we will also discuss potential complications and suggest techniques to minimize the recurrence of such untoward events.