The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

Alternative Pathways of Delivering Cardiac Resynchronization Therapy: A Single Center 10 Year Experience on 400 Consecutive…


Heart failure (HF) can be either induced or aggravated by the existence of left ventricular (LV) intraventricular dyssynchrony (IVD). Cardiac resynchronization therapy (CRT) can potentially correct LV-IVD in well-characterized populations (see current Guidelines). CRT has demonstrated clear benefits in both soft (NYHA class, 6MWT, QoL) and hard (all cause mortality, 6 months hospitalizations) randomized control trial (RCT) endpoints. The standard approach is to deliver a unipolar (UP)/bipolar (BP) dedicated LV-lead via the coronary sinus (CS) into a postero-lateral (PL) tributary vein.
Suboptimal LV-lead positioning has been long recognized as an important cause of CRT non-response. Optimal, delay targeted LV-lead placement might sometimes only be possible with non-standard techniques due to various patient particularities. We decided to retrospectively evaluate the frequencies and types of techniques we used in over a decade of CRT experience in our centre. “Alternative CRT” is not yet a coined term. We defined unexpendable variations from the straightforward technique as alternative pathways of delivering CRT.