[Strategies to avoid complications and to solve technical problems during the implantation of CRT and CRT-D systems]

Cardiac resynchronization with or without antitachycardiac treatment is now an established option to improve the functional status, morbidity and mortality of patients with severe symptomatic systolic heart failure, ventricular conduction delay and asynchrony. Increasing implant numbers are to be expected. The transvenous left ventricular lateral lead placement can now be achieved in up to 97% of patients. But due to the coronary venous anatomy it may still constitute a challenge even for experienced pacemaker and ICD implanters. In addition, it confers a considerable risk for complications like coronary sinus dissection and perforation, diaphragmatic stimulation and lead dislodgement. An overview is given on possible technical problems, solutions, complications and preventive strategies.