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World J Cardiol. Dec 26, 2014; 6(12): 1270-1277
Published online Dec 26, 2014. doi: 10.4330/wjc.v6.i12.1270
Cardiac resynchronization therapy: Dire need for targeted left ventricular lead placement and optimal device programming
Sokratis Pastromas, Antonis S Manolis
Sokratis Pastromas, Antonis S Manolis, Department of Cardiology, Evagelismos Hospital, and Athens University School of Medicine, 10676 Athens , Greece
Author contributions: Pastromas S reviewed the literature, composed and wrote the article; Manolis AS conceived the topic and the title, made suggestions, provided literature, critically reviewed and edited the article, made corrections and guided the initial submission and revision process.
Correspondence to: Antonis S Manolis, MD, Department of Cardiology, Evagelismos Hospital, and Athens University School of Medicine, Ypsilantou 45-47, 10676 Athens, Greece. asm@otenet.gr
Telephone: +30-213-2041493 Fax: +30-213-2041495
Received: June 20, 2014
Revised: July 27, 2014
Accepted: October 31, 2014
Published online: December 26, 2014
Processing time: 191 Days and 10 Hours
Abstract

Cardiac resynchronization therapy (CRT) effected via biventricular pacing has been established as prime therapy for heart failure patients of New York Heart Association functional class II, III and ambulatory IV, reduced left ventricular (LV) function, and a widened QRS complex. CRT has been shown to improve symptoms, LV function, hospitalization rates, and survival. In order to maximize the benefit from CRT and reduce the number of non-responders, consideration should be given to target the optimal site for LV lead implantation away from myocardial scar and close to the latest LV site activation; and also to appropriately program the device paying particular attention to optimal atrioventricular and interventricular intervals. We herein review current data related to both optimal LV lead placement and device programming and their effects on CRT clinical outcomes.

Keywords: Heart failure; Cardiac dyssynchrony; Left bundle branch block; Cardiac resynchronization therapy; Biventricular pacing

Core tip: Cardiac resynchronization therapy has been established as a cornerstone therapy in symptomatic patients with heart failure, severe systolic left ventricular (LV) function and widened QRS complex. In order to achieve high percentage of biventricular pacing and to reduce the number of non-responders, consideration should be given to target the optimal site for LV lead implantation away from myocardial scar and close to the latest LV site activation; and also to appropriately program the device paying particular attention to optimal atrioventricular and interventricular intervals.