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Updated: May 8, 2026
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Effect of ventricular leads position on the clinic outcome of cardiac resynchronization therapy
Ying-xue Dong1, Javin Boodhna, Yan-zong Yang
1Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
Insights
Right ventricular lead position does not impact cardiac resynchronization therapy (CRT) response. Optimal left ventricular (LV) lead placement is crucial for CRT success, avoiding the LV apex.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Cardiac resynchronization therapy (CRT) is a key treatment for heart failure.
- Optimizing lead placement is essential for CRT efficacy.
- The role of specific lead positions requires further clarification.
Purpose of the Study:
- To evaluate the impact of right ventricular (RV) lead position on CRT outcomes.
- To determine the optimal left ventricular (LV) lead placement for CRT response.
- To assess the influence of myocardial scar on LV lead positioning.
Main Methods:
- Analysis of patient data undergoing CRT implantation.
- Comparison of clinical outcomes based on RV lead position (RVA vs. RVHS).
- Evaluation of LV lead placement in various regions (posterior, anterior, lateral, apex) and correlation with scar tissue.
Main Results:
- RV lead position (RVA or RVHS) showed no significant difference in CRT response.
- LV lead placement is a critical factor for successful CRT.
- Optimal LV pacing sites are in latest activated regions or areas without transmural myocardial scar.
- LV lead placement in the apex is associated with suboptimal outcomes.
- No significant difference in outcomes was observed for posterior, anterior, and lateral LV lead positions.
Conclusions:
- RV lead positioning does not significantly affect CRT response.
- LV lead placement is paramount for CRT efficacy, with specific sites being more favorable.
- Avoiding the LV apex for lead placement is recommended based on current evidence.
Abstract:
The RV lead position, either RVA or RVHS appears to make no difference in the response to CRT but the LV lead placement play a vital role.9,30 The latest activated regions of LV or areas without transmural myocardial scar for an optimal CRT are preferred. Currently, data demonstrate that no significant difference of clinical outcomes in posterior, anterior, and lateral LV lead position was found, while the ideal pacing site of the LV should be avoided in the apex position as suggested in COMPANION trial and MADIT-CRT trial. And dual-site LV CRT, which is a new technique, is also still in progress and we are looking forward to getting more updates from that.
