Where are the left ventricular leads really implanted? a study of 90 consecutive patients

Background: Cardiac resynchronization therapy (CRT) is a recognized treatment for severe heart failure. The recommended left ventricular (LV) lead position is at the lateral or posterolateral wall. However, LV leads cannot always be implanted at the expected site. The aim of our study was to describe in a large series of patients the anatomical position really achieved by LV leads at implant. Method: In consecutive patients referred for CRT, we determined the LV lead implantation success rate, the success rate for the initial target vein, and the final position achieved by the tip of the LV lead in the left and right anterior oblique projections. Results: Ninety patients (66 men, 71 +/- 9 years, 20% New York Heart Association (NYHA) class IV) were referred for an LV lead implantation between September 2003 and March 2006. A LV lead could be implanted in 92% of patients. In 70%, LV leads were implanted in the initial target vein. The final location was lateral or posterolateral in 68% and anterior or anterolateral in 32% of patients. The mean procedural time was 117 +/- 42 minutes. Conclusions: LV lead implantation was achieved in 92% of patients with mean procedure duration of less than 2 hours. Nevertheless, 30% of LV leads were implanted outside of the initial target vein and 32% at the anterior or anterolateral wall. Further studies are warranted to compare the responder rate to CRT when the LV lead is at the lateral or posterolateral wall or when the LV lead is at an alternative site.