Objectives To analysis the application of retrograde coronary venography (RCV) in left ventricular lead implementation during cardiac resynchronisation therapy (CRT).

Methods A total of 31 patients (21 men and 10 women,mean age 63.1 ± 8.0 years) with NYHA class III∼IV received CRT from March 2009 to December 2011. The etiologies of heart failure were idiopathic dilatedcardiomyopathy in 22, ischaemic heart disease in 7, alcoholic cardiomyopathyin 1 and valvular heart disease in 1. Indications were LVEF ≤ 0.35 andleft ventricular end-diastolic dimension > 55 mm. Vein trail andleft ventricular lead were selected according to different venous anatomy inorder to obtain ideal pacing position.

Results RCV were performed by different positions. left ventricular lead were located in 12, posterior lateralvein in 12 and posterior vein in 5. Another 2 were failed to located in veins successfully because of abnormal coronary vein anatomy and were finally located in left lateral epicardium by thoracotomy. Dissection took palce in 2 patients but were not influenced procedure with stable haemodynamics. There were no myocardial perforation or vein stenosis. 25 in 29 patients needed a PTCA wire in the procedure.

Conclusions Carefull manipulation and proper selection of cather and lead can decrease the rate of complication in CRT despite of the diversity of coronery vein anatomy..