Cardiac resynchronization therapy: alternative methods of left ventricular electrode implantation

Cardiac resynchronization therapy (CRT) is an effective surgical treatment for heart failure (HF) with reduced ejection fraction when drug therapy is ineffective. By reducing electrical dissynchrony, CRT enhances systolic and diastolic heart function, leading to symptoms improvement, decreasing hospitalization rate, as well as cardiovascular mortality. Nevertheless, in 5-10% of cases CRT may be troublesome due to small coronary sinus diameter, pronounced tortuosity of the coronary venous system, high left ventricle (LV) threshold values, diaphragm nerve stimulation and other factors. Some patients do not respond to CRT because of suboptimal left ventricular lead location, incorrect selection of patients, inadequate device programming parameters, etc. To overcome these issues alternative techniques such as minithoracotomy, thoracoscopic, robotic-assisted as well as transseptal, transapical and transventricular approaches to LV-lead implantation are developed and described in details by the authors. Particular attention is paid to conduction system pacing and leadless LV endocardial pacing system, that are also observed in this article.

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