I'm so sorry for this difficult and long one, but I really need you want to record it. Natural and clear one, please.
The topics of my talk today is CRT-D pacing site selection. There are several issues concerned with site selection during CRT-D implantation, such as shock lead placement to reduce DFT and coronary vein selection for LV lead to obtain anti-heart failure effect.
In my presentation, I would like to focus on mainly LV lead positioning to maximize the efficacy of CRT. This slide shows the definition of cardiac veins. The distal coronary vain accompany with LAD is anterior inter-ventricular branch (AIV), the branch originating from anterior site of coronary sinus and running to lateral on LAO view is antero-lateral vein, the branch from lateral site, around three o’clock of CS, is latral, and the branch from posterior is posterior-lateral vein. Because implantation of LV lead is almost performed using transvenous technique through the coronary vein, site selection of LV pacing completely depends on CV anatomy. Therefore, I think that preoperative anatomical assessment is very useful to identify the CV with appropriate diameter in the region of latest LV, to predict the technical difficulty, and to select the appropriate equipment. To make preoperative anatomical assessment, the visualization of CV anatomy is essential. There are two methods to identify CV anatomy before CRT implantation, that is Venous phase of coronary angiography and Multi-slice CT. This movie shows CAG in patients with heart failure and complete left bundle branch block. Almost all patients underwent CAG to investigate the etiology of heart failure. During routine CAG, to keep pedal on the foot switch until venous phase is useful to know CV anatomy. As you can see good lateral vein for LV lead insertion
in this patient.
