Use of coronary venous angioplasty to facilitate optimal placement of left ventricular lead during CRT.

Cardiac resynchronization therapy (CRT) has become an accepted treatment for selected patients with drug-resistant heart failure. In some cases CRT implantation can be difficult, particularly optimal left ventricular stimulation through proper lead placement. Difficulties can arise from venous stenosis, atypical and tortuous coronary sinus anatomy, presence of venous valves, postoperative deformation, and absence of vessels in the target location. Various methods adapted from percutaneous coronary artery intervention can be applied to resolve these problems and ensure a good lead position.