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**90**

**93**

**Chapter 6**

**Abstract**

**1. Introduction**

programming [5–10].

The Importance of Lead

Clinical Outcomes in Cardiac

*Mirela-Anca Stoia, Sabina Istratoaie, Sorin Pop, Florin Anton,* 

Left ventricular (LV) lead positioning is one of the main contributors to the cardiac resynchronization therapy (CRT) response. Conventional left ventricular (LV) lead implantation faces several difficulties, which may ultimately affect lead stability and performance. Several imaging techniques 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. Emerging pacing strategies like LV multisite and multipoint pacing may help deliver an enhanced response to CRT, but prospective trials are warranted to

**Keywords:** cardiac resynchronization therapy, left ventricular lead implant, coronary

Cardiac resynchronization therapy (CRT) exerts its physiological effect by restoring the atrioventricular, interventricular, and intraventricular synchronicity. This in turn results in an enhancement in pumping efficiency. In addition, CRT leads to an improved left ventricular (LV) filling and, in some cases, a reduction in the mitral regurgitation. The beneficial effects of CRT translate in a majority of patients in an improved quality of life, increased exercise capacity, reduction in hospitalization for heart failure, and reduction in overall mortality [1–3].

In spite of all these advantages, a substantial minority (approximately 30%) of patients treated with CRT do not show clinical improvement [3, 4]. The reasons for non-response to CRT include: lack of LV dyssynchrony, non-optimal position of the LV pacing lead, high-myocardial scar burden, and suboptimal device

Given these considerations, the aim of this chapter was to review the different

strategies of lead placement for CRT and their effect on clinical outcomes.

Resynchronization Therapy

Positioning to Improve

*Sorin Crisan and Dan Blendea*

confirm the superiority of this approach.

sinus, coronary venous tree, left bundle branch block

## **Chapter 6**
