Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure patients with severely obvious left ventricular ejection fraction (LVEF) and evidence of cardiac dyssynchrony.1-3 With conventional biventricular stimulation,notable left ventricular (LV) reverse remodeling,the most reliable predictor of long-term survival in CRT patients,is achieved in only 60％-70％ of the patients.4,5 Lack of LV dyssynchrony,non-optimal position of the LV pacing lead,high-myocardial scar burden,and sub-optimal device programming have been related to non-response to CRT.6-8 Particularly,the optimal placement of LV lead in a tributary of the coronary sinus is one of the most challenging technique of CRT device implantation.This article will discuss the effect of ventricular leads on the clinic outcome after CRT and how to locate the optimal ventricular leads to maximize the haemodynamic benefits of CRT and provide superior longterm outcome.
患者女,58岁,因＂反复胸闷、心悸4个月,加重4d＂入大连医科大学附属第一医院.患者于2010年12月开始反复出现情绪激动时发作性胸闷、心悸,持续数分钟后缓解,并曾出现晕厥1次.动态心电图提示频发室性早搏（2495次/24 h）、室性心动过速（室速,146阵,最长持续2 min）,冠状动脉CT提示左前降支、左回旋支粥样硬化,右冠状动脉粥样硬化伴轻度狭窄.患者于2011年3月15日植入心律转复除颤器（ICD,Marquis DR 7274,美国美敦力公司）.
