New tools for the effective delivery of cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) has been shown to provide symptom relief to many patients who have congestive heart failure (CHF). Still, there are technical concerns with implanting CRT systems, and these range from inadequate venous anatomy to a variety of left ventricular (LV) lead problems. Fortunately, there are several new implant tools to help physicians achieve a stable and adequate LV pacing site. There are a number of guiding catheter shapes to tailor the choice to specific anatomic abnormalities that may be encountered during implants. Key to success was the development of over-the-wire LV leads that are capable of maneuvering within complex venous anatomy. Improvements in LV leads have included increasing lead diameter and bipolar design. In some cases, epicardial LV lead placement may be necessary at surgery. The latest systems have begun to integrate disease management modalities, which hopefully will reduce the need for CHF hospitalizations.