Technical considerations in implanting left ventricular pacing leads for cardiac resynchronisation therapy

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Abstract
Cardiac resynchronisation therapy usually requires implantation of a left ventricular lead. The coronary venous approach is nowadays preferred for this purpose because of the less invasive nature compared to direct epicardial stimulation. Optimal hemodynamic support, accessibility of the desired vein location and adequate pacing parameters without phrenic nerve stimulation are the three most important aspects for successful left ventricular lead implantation. The highly variable anatomy of the coronary venous system can sometimes cause difficulties but in experienced hands, implant success rates of more than 95% can be achieved. In this article, the potential problems and pitfalls in implanting left ventricular leads and potential solutions to problematic cases are discussed.

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