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Updated: Jun 5, 2026

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Cardiac resynchronization therapy: can left ventricular lead position make the difference?

Renata Gomes¹, José Miguel Santos, João Abecasis

¹Serviço de Cardiologia, Hospital de Santa Cruz-CHLO, Lisboa, Portugal. renatagomes50@hotmail.com

Revista Portuguesa De Cardiologia : Orgao Oficial Da Sociedade Portuguesa De Cardiologia = Portuguese Journal of Cardiology : an Official Journal of the Portuguese Society of Cardiology

|January 27, 2011

Summary

Cardiac resynchronization therapy (CRT) improved heart failure in an elderly patient. Optimal lead placement in the posterolateral position was crucial for a positive clinical and echocardiographic response.

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Published on: January 31, 2019

Area of Science:

Cardiology
Cardiac Electrophysiology

Background:

Non-ischemic dilated cardiomyopathy can lead to worsening heart failure despite optimal medical management.
Cardiac resynchronization therapy (CRT) is indicated for eligible patients with heart failure and ventricular dyssynchrony.

Observation:

An 82-year-old female patient with non-ischemic dilated cardiomyopathy presented with advanced heart failure symptoms.
Initial implantation of a CRT-P device encountered technical difficulties, resulting in left ventricular lead placement in the anterior coronary vein.

Findings:

The initial lead placement in the anterior coronary vein yielded no clinical benefit.
Repositioning the left ventricular lead to the posterolateral position resulted in significant clinical improvement and positive echocardiographic changes.

Implications:

This case highlights the critical importance of optimal left ventricular lead placement for successful CRT outcomes.
Appropriate lead positioning can significantly enhance the efficacy of CRT in patients with non-ischemic dilated cardiomyopathy.
Technical challenges in lead implantation necessitate careful consideration and potential revision for optimal patient response.