Cardiac resynchronization therapy is a new therapy for advancedheart failure patients. This therapy has been shown to improvequality of life, exercise capacity, NYHA classification, and evenreverse the detrimental "reverse remodeling" that occurs inadvanced heart failure - in patients already receiving optimalpharmacological therapy.The typical patient has NYHA III/IV HF symptoms, a QRS > 120ms, LVEDD > 55 mm, without any indication required for pacing.The therapy is available in an ICD device, too. CRT has been shownto be effective in patients with both ischemic and non-ischemiccardiomyopathy.The implant procedure is part of a learning curve. Manyphysicians who already perform electrophysiology procedures, orPPM, or ICD implants are the ideal implanter - but are surprised atthe challenges this implant presents. This book will help "flatten"the learning curve for new physician implanting, and will provide a"guide' for those who have already started implanting.The success rate is about 90% - so after 10 years ofapplication, we have found that there are still patients who do notget access to this great therapy because of the complexity of thepatient's anatomy, or physician skills.The book is written by three authors with a great deal ofexperience culminating in over 3000 cases between them.This book is intended for cardiologists who currently implanteither or both pacemakers and cardioverter defibrillators withcardiac resynchronization therapy (also called bi-ventricularpacing), or plan to implant in the future. This book will beextremely useful for the new cardiologist in training who islearning to implant devices.

Dedication.Foreword.General remarks.1 How does ventricular dyssynchrony alter hemodynamicfunction?.2 What clinical benefits can we expect from CRT?.3 How to select candidates for CRT.4 Assessment of ventricular dyssynchrony by newechocardiographic analyses.5 What are the mechanisms of improvement during CRT?.6 Clinical situations where CRT is unlikely to be of therapeuticvalue.7 Preimplantation checklist.8 Right versus left-sided approach to implant the CRTsystem.9 Right ventricular pacing in CRT.10 How to achieve reliable sensing and pacing of the rightatrium.11 Is it safe to pace the left ventricle via a coronary sinustributary?.12 Why perform a coronary sinus venogram before placement ofthe.left ventricular lead?.13 Optimal LV lead positioning.14 How to manage difficult coronary sinus cannulation.15 How to avoid a dissection of the coronary sinus ostium.16 How to overcome a myocardial bridge over the coronarysinus.17 What to do in the absence of a lateral branch on thevenogram.18 How to manage high left ventricular pacing thresholds.19 How to proceed in the presence of a complex coronary sinusanatomy.20 How to manage diminutive target coronary sinustributaries.21 What to do when valves are in the way.22 How to implant a CRT system in the presence of a leftsuperior vena cava.23 Dilatation of the target cardiac vein by angioplastytechniques.24 Stenting for recurrent dislodgment of the left ventricularlead.25 Assessment of the electrical signal sensed by the leftventricular lead.26 How to avoid stimulating the left phrenic nerve.27 Dye extravasation and venous perforation or dissection.28 How to avoid a cardiac vein dissection by the ballooncatheter.29 How to remove the guiding sheath using the slittingtechnique.30 Radiographic appearance of the final lead position of the CRTsystem.31 How to implant a CRT device in patients with chronic atrialfibrillation.32 Upgrading DDD pacing to CRT.33 Upgrading a CRT to a CRT-ICD system.34 Repositioning of a dislodged left ventricular lead.35 How to implant a four-chamber CRT system.36 How to implant a biventricular, double-left ventricular leadCRT system.37 Alternatives in left ventricular lead implant failures.38 Left ventricular lead extraction.39 Management of ventricular double counting in CRT.40 Management of non-responders to CRT.References.Index.