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Pacing in heart failure: how many leads and where?

Cardiology Division, University of South Florida and Tampa General Hospital, Tampa, Florida, USA

Correspondence to:
Dr S Serge Barold, 5806 Mariner’s Watch Drive, Tampa FL 33615, USA; ssbarold@aol.com

The first 150 words of the full text of this article appear below.

The major randomised trials that established the benefit of cardiac resynchronisation therapy (CRT) in congestive heart failure (CHF) all involved right and left ventricular pacing. Right ventricular (RV) pacing was used empirically with little relevance to haemodynamic benefit. The best site for left ventricular (LV) pacing via the coronary venous system is the mid-portion of the lateral or posterolateral wall in patients with LV septal–posterior wall mechanical dyssynchrony. It is thought that the widest separation of RV and LV leads produces the best CRT result. LV stimulation should be applied at the site of latest activation or latest contraction for the greatest haemodynamic response. The site producing the narrowest QRS complex during biventricular (BiV) pacing is of little value in determining the best LV pacing site to correct mechanical dyssynchrony. Placement of the LV lead is highly dependent on coronary venous anatomy, lead stability, pacing thresholds and the absence of . . . [Full text of this article]

Relevant Article

Comparison of temporary bifocal right ventricular pacing and biventricular pacing for heart failure: evaluation by tissue Doppler imaging

R E Lane, J Mayet, N S Peters, D W Davies, and A W C Chow
Heart 2008 94: 53-58. [Abstract] [Full Text] [PDF]