131:
1954:
25:
425:
278:(ICD), to quickly terminate an abnormally fast, life-threatening heart rhythm. CRT and CRT-D have become increasingly important therapeutic options for patients with moderate and severe heart failure. CRT with pacemaker only is often termed "CRT-P" to help distinguish it from CRT with defibrillator (CRT-D).
441:
CRT requires the placement of an electrical device for biventricular pacing, along with placement of (at least) two pacing leads, to facilitate stable left ventricular and right ventricular pacing. For all elements, the first stage of the process is local anaesthetic followed by incision to allow for
497:
Left ventricular lead placement is the most complicated and potentially hazardous element of the operation, due to the significant variability of coronary venous structure. Alterations in heart structure, fatty deposits, valves and natural variations all cause additional complications in the process
1131:
Zhou, Weihua; Hou, Xiaofeng; Piccinelli, Marina; Tang, Xiangyang; Tang, Lijun; Cao, Kejiang; Garcia, Ernest V.; Zou, Jiangang; Chen, Ji (December 2014). "3D fusion of LV venous anatomy on fluoroscopy venograms with epicardial surface on SPECT myocardial perfusion images for guiding CRT LV lead
575:
Several research papers have proposed software platforms for planning and guiding the implantation of CRT devices. This research proposes using pre-operative images to characterize tissue and left ventricle activation to identify potential target regions for deploying the CRT leads.
506:
The device is inserted in a subcutaneous pocket created by the surgeon, the choice of left or right side of the chest wall is determined mainly by the patient's preference or location of preexisting device. The device, similar to that of a traditional
1026:
Auricchio, Angelo; Gasparini, Maurizio; Linde, Cecilia; Dobreanu, Dan; Cano, Óscar; Sterlinski, Maciej; Bogale, Nigussie; Stellbrink, Christoph; Refaat, Marwan M.; Blomström-Lundqvist, Carina; Lober, Christiane (September 2019).
897:
Sinitca, Aleksandr; Chmelevsky, Mikhail; Arduino, Chiara; Zubarev, Stepan; Shirshin, Aleksandr; Dokuchaev, Arsenii; Budanova, Margarita; Khamzin, Svyatoslav; Bazhutina, Anastasia; Rud, Sergei; Rainer, Werner (2023-11-26).
493:
Once the phlebogram has been obtained, the multi-delivery catheter is used to guide in the lead, from the chosen vein of entry, into the right atrium, through the coronary sinus and into the relevant cardiac vein.
458:, through to the right ventricle. The guide wire is then used to assist in the placement of the electrode lead, which travels through the venous system into the right ventricle where the electrode is embedded.
1077:
302:, contributing to poor left ventricular coordination and reduced systolic function, thereby reduced ejection fraction (<35%). This reduction in ejection fraction is considered heart failure.
840:"Effective cardiac resynchronization therapy for an adolescent patient with dilated cardiomyopathy seven years after mitral valve replacement and septal anterior ventricular exclusion"
660:
Choi, Anthony J.; Thomas, Sunu S.; Singh, Jagmeet P. (2016). "Cardiac
Resynchronization Therapy and Implantable Cardioverter Defibrillator Therapy in Advanced Heart Failure".
313:(NICE) guidelines state that CRT-D device placement is inappropriate for class IV heart failure, but placement of CRT-P devices may be appropriate in certain circumstances.
431:
of cardiac resynchronization therapy with defibrillator (CRT-D) in an individual with dilated cardiomyopathy after mitral valve replacement (MVR). The leads are:
306:
498:
of cannulation. However, this risk can be reduced using AI-based preoperative visualization of LV venous anatomy using computer tomography (CT) imaging.
42:
310:
147:
143:
89:
317:
NICE Guidelines for
Treatment Options with ICD or CRT for Heart Failure Patients with Left Ventricular Dysfunction with an LVEF of 35% or less
61:
1193:
977:
Brambatti, M.; Guerra, F.; Matassini, M. V.; Cipolletta, L.; Barbarossa, A.; Urbinati, A.; Marchesini, M.; Capucci, A. (5 February 2013).
531:). A 2013 study showed that CRT improved the left ventricular ejection fraction (LVEF) by an average of 10.6% 12 months after placement.
68:
1902:
1228:
1324:
467:
466:
This is generally performed subsequent to RV lead placement, with the RV lead providing a backup in case of accidental damage to the
75:
1076:
Mountney, P.; Behar, J. M.; Toth, D.; Panayiotou, M.; Reiml, S.; Jolly, M. P.; Karim, R.; Zhang, L.; Brost, A. (November 2017).
1722:
1312:
275:
57:
1597:
607:"Cardiac Resynchronization Therapy Technique: Approach Considerations, Placement of Pacing Leads, Programming of Device"
1976:
1847:
1523:
1428:
644:
108:
1186:
979:"Cardiac resynchronization therapy improves ejection fraction and cardiac remodelling regardless of patients' age"
1735:
1542:
783:"Indications of Cardiac Resynchronization in Non-Left Bundle Branch Block: Clinical Review of Available Evidence"
707:"Implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure"
838:
Mima, Takahiro; Baba, Shiro; Yokoo, Noritaka; Kaichi, Shinji; Doi, Takahiro; Doi, Hiraku; Heike, Toshio (2010).
478:. The catheter is subsequently maneuvered to the opening of the coronary sinus in the right atrium. From here a
1835:
1532:
82:
46:
1857:
900:"A Machine Learning-Based Approach for Automatic Coronary Sinus Vein Segmentation and Anatomy Reconstruction"
424:
1981:
1842:
1830:
1711:
1358:
508:
290:(LBBB) of the heart, a cardiac abnormality leading to delayed left ventricular contraction. LBBB causes a
1957:
1179:
734:"Indications for Cardiac Resynchronization Therapy: A Comparison of the Major International Guidelines"
1789:
1679:
1482:
1433:
1223:
1868:
1852:
1319:
1302:
287:
154:
174:
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35:
1910:
520:
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1941:
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1915:
1472:
1285:
1280:
1171:
544:
487:
899:
8:
1794:
1772:
1458:
1297:
1270:
299:
263:. Right ventricular access is direct, while left ventricular access is conferred via the
1777:
1690:
1686:
1632:
1627:
1568:
1489:
1397:
1346:
1260:
1113:
1058:
874:
839:
815:
782:
474:. As with the RV lead, a guide wire is first inserted, allowing for the insertion of a
511:, is generally no larger than a pocket watch and has inserts for the electrode leads.
1820:
1766:
1696:
1604:
1592:
1453:
1443:
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1292:
1203:
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1062:
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959:
951:
879:
861:
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685:
677:
640:
442:
approach from the appropriate vein. From here, the leads and device can be inserted.
229:
210:
138:
130:
1920:
1825:
1563:
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1408:
1381:
1376:
1141:
1117:
1089:
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990:
941:
910:
869:
851:
810:
794:
745:
669:
428:
248:
454:
is made, and a guide wire inserted into the vein, where it is guided, with use of
1892:
1814:
1661:
1651:
1637:
1528:
1498:
1404:
1233:
1218:
252:
160:
1045:
1028:
946:
929:
1799:
1784:
1580:
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1388:
1372:
1307:
1145:
750:
733:
555:
479:
264:
214:
995:
978:
673:
552:
Bleeding and pocket haematoma, each of which with an incidence of less than 1%
1970:
1936:
1656:
1275:
1153:
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1093:
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955:
865:
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681:
260:
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233:
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767:
689:
559:
451:
706:
1878:
1621:
1585:
1265:
1250:
523:, and improve quality of life, walking distance, and peak oxygen uptake (
519:
Several studies have also shown that CRT can decrease mortality, reverse
455:
295:
291:
241:
237:
1078:"A Planning and Guidance Platform for Cardiac Resynchronization Therapy"
184:
1873:
1740:
1645:
1413:
483:
781:
Henin, M; Ragy, H; Mannion, J; David, S; Refila, B; Boles, U (2020).
563:
222:
206:
168:
549:
Inability to cannulate coronary sinus (approximately 5% of patients)
543:
Dissection or perforation of coronary sinus which can in turn cause
221:
by coordinating the function of the left and right ventricles via a
24:
1029:"Sex-Related Procedural Aspects and Complications in CRT Survey II"
798:
482:
is injected, allowing the surgical team to obtain a coronary sinus
475:
471:
976:
524:
236:, where electrical activity has been compromised, with prolonged
1537:
1025:
896:
247:
The insertion of electrodes into the ventricles is done under
1886:
1716:
1547:
1392:
1207:
1201:
1075:
486:
to direct the placement of the lead into the most suitable
731:
928:
Leyva, Francisco; Nisam, Seah; Auricchio, Angelo (2014).
225:, a small device inserted into the anterior chest wall.
305:
Heart failure patients are generally considered if in
251:, with access to the ventricles most commonly via the
1130:
780:
732:
Normand, C; Linde, C; Singh, J; Dickstein, K (2018).
927:
837:
445:
437:- Left ventricular lead through the coronary sinus.
49:. Unsourced material may be challenged and removed.
461:
711:National Institute for Health and Care Excellence
311:National Institute for Health and Care Excellence
274:) also incorporate the additional function of an
1968:
566:, all of which have an incidence of less than 1%
930:"20 Years of Cardiac Resynchronization Therapy"
659:
213:of the heart, as well as on occasion the right
970:
353:ICD only if high risk of sudden cardiac death
309:(NYHA) class II or III heart failure. Current
1187:
989:(5). Oxford University Press (OUP): 704–710.
934:Journal of the American College of Cardiology
653:
255:, although access may be conferred from the
831:
701:
699:
1229:Cardiology diagnostic tests and procedures
1194:
1180:
129:
1325:Transcatheter pulmonary valve replacement
1044:
994:
945:
921:
873:
855:
814:
774:
749:
109:Learn how and when to remove this message
1368:shunt from heart chamber to blood vessel
696:
423:
228:CRT is indicated in patients with a low
1468:shunt from blood vessel to blood vessel
639:. USA: Elsevier Saunders. p. 379.
634:
1969:
400:≥150 milliseconds with or without LBBB
276:implantable cardioverter-defibrillator
1598:Valve-sparing aortic root replacement
1337:enlargement of existing septal defect
1175:
433:- Atrial lead at the right appendage
1332:production of septal defect in heart
1082:IEEE Transactions on Medical Imaging
630:
628:
626:
601:
599:
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595:
593:
591:
589:
435:- Right ventricular lead at the apex
47:adding citations to reliable sources
18:
907:2023 Computing in Cardiology (CinC)
501:
58:"Cardiac resynchronization therapy"
13:
1429:transposition of the great vessels
1354:creation of septal defect in heart
14:
1993:
1729:Cardiac resynchronization therapy
844:Journal of Cardiothoracic Surgery
623:
586:
362:120–149 milliseconds without LBBB
195:Cardiac resynchronisation therapy
124:Cardiac resynchronization therapy
1953:
1952:
1033:JACC: Clinical Electrophysiology
534:
446:Right ventricular lead placement
23:
1736:Left atrial appendage occlusion
1124:
1069:
1019:
462:Left ventricular lead placement
232:(typically <35%) indicating
34:needs additional citations for
940:(10). Elsevier BV: 1047–1058.
890:
725:
381:120–149 milliseconds with LBBB
286:The key indication for CRT is
281:
1:
1858:Radionuclide ventriculography
579:
570:
1843:Myocardial perfusion imaging
1134:JACC: Cardiovascular Imaging
468:electric fibers of the heart
7:
1046:10.1016/j.jacep.2019.06.003
947:10.1016/j.jacc.2014.06.1178
539:Key complications include:
521:left ventricular remodeling
514:
16:Treatment for heart failure
10:
1998:
1450:for univentricular defect
1146:10.1016/j.jcmg.2014.09.002
751:10.1016/j.jchf.2018.01.022
307:New York Heart Association
1977:Cardiac electrophysiology
1950:
1929:
1901:
1790:Implantable loop recorder
1758:
1613:
1509:
1434:Arterial switch operation
1249:
1242:
1224:Interventional cardiology
1214:
674:10.1016/j.hfc.2016.03.010
419:
352:
323:
181:
167:
153:
137:
128:
123:
1869:Coronary catheterization
1359:Blalock–Hanlon procedure
1320:Mitral valve replacement
1303:Aortic valve replacement
1094:10.1109/TMI.2017.2720158
917:– via IEEE Xplore.
288:left bundle branch block
1865:Cardiac catheterization
1807:Electrophysiology study
1707:Radiofrequency ablation
1672:Alcohol septal ablation
996:10.1093/europace/eus376
476:multi-delivery catheter
456:real time X-ray imaging
1911:Impedance cardiography
1533:Coronary artery bypass
915:10.22489/CinC.2023.220
857:10.1186/1749-8090-5-47
637:Goldman-Cecil Medicine
611:emedicine.medscape.com
556:Myocardial perforation
438:
209:in the left and right
205:) is the insertion of
1942:Transcutaneous pacing
1746:Heart transplantation
1667:Ventricular reduction
1483:Blalock–Taussig shunt
662:Heart Failure Clinics
635:Goldman, Lee (2012).
427:
294:prolongation of ≥120
1916:Ballistocardiography
1473:systemic circulation
545:pericardial effusion
349:<120 milliseconds
270:CRT defibrillators (
240:duration to >120
43:improve this article
1982:Implants (medicine)
1795:Cardiac stress test
1773:Electrocardiography
1712:Pacemaker insertion
1459:Kawashima procedure
1423:compound procedures
1298:Aortic valve repair
1271:Mitral valve repair
787:Cardiology Research
738:JACC: Heart Failure
318:
1848:Cardiovascular MRI
1778:Vectorcardiography
1633:Pericardial window
1628:Pericardiocentesis
1569:Drug-eluting stent
1398:Rastelli procedure
1347:Balloon septostomy
439:
316:
1964:
1963:
1821:Angiocardiography
1767:Electrophysiology
1754:
1753:
1697:Catheter ablation
1680:Conduction system
1605:LeCompte maneuver
1593:Bentall procedure
1454:Norwood procedure
1444:Senning procedure
1439:Mustard procedure
1342:Atrial septostomy
1293:Valve replacement
1140:(12): 1239–1248.
1088:(11): 2366–2375.
429:Chest radiographs
417:
416:
300:electrocardiogram
230:ejection fraction
192:
191:
119:
118:
111:
93:
1989:
1956:
1955:
1921:Cardiotocography
1889:
1853:Ventriculography
1826:Echocardiography
1817:
1769:
1685:Maze procedure (
1682:
1648:
1624:
1577:
1576:Obstacle removal
1564:Bare-metal stent
1560:
1520:
1477:pulmonary artery
1469:
1424:
1409:pulmonary artery
1382:Fontan procedure
1377:pulmonary artery
1369:
1333:
1247:
1246:
1196:
1189:
1182:
1173:
1172:
1166:
1165:
1128:
1122:
1121:
1073:
1067:
1066:
1048:
1039:(9): 1048–1058.
1023:
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1016:
998:
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968:
967:
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925:
919:
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904:
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835:
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703:
694:
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657:
651:
650:
632:
621:
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502:Device placement
319:
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249:local anesthetic
185:edit on Wikidata
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1925:
1897:
1893:Phonocardiogram
1885:
1815:Cardiac imaging
1813:
1765:
1750:
1678:
1662:Septal myectomy
1652:Cardiomyoplasty
1644:
1638:Pericardiectomy
1620:
1609:
1575:
1556:
1516:
1510:Cardiac vessels
1505:
1499:Glenn procedure
1467:
1422:
1405:right ventricle
1367:
1331:
1253:
1238:
1234:Cardiac imaging
1219:Cardiac surgery
1210:
1200:
1170:
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582:
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528:
517:
504:
472:asystolic event
464:
448:
436:
434:
432:
422:
410:CRT-P or CRT-D
391:CRT-P or CRT-D
284:
253:subclavian vein
188:
175:1839506-devices
173:
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28:
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1903:Function tests
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1800:Bruce protocol
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1785:Holter monitor
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1595:
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1581:Endarterectomy
1578:
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1558:Coronary stent
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1389:left ventricle
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1308:Ross procedure
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1244:
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1226:
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1206:involving the
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799:10.14740/cr989
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356:Not indicated
354:
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265:coronary sinus
261:cephalic veins
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1937:Cardioversion
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1684:
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1677:
1676:
1673:
1670:
1668:
1665:
1663:
1660:
1658:
1657:Dor procedure
1655:
1653:
1650:
1647:
1643:
1642:
1639:
1636:
1634:
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32:This article
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1728:
1725:implantation
1719:implantation
1702:Cryoablation
1543:Off-pump CAB
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1261:Valve repair
1251:Heart valves
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1132:placement".
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41:Please help
36:verification
33:
1879:Cardiac PET
1622:Pericardium
1586:Atherectomy
1524:Angioplasty
1266:Valvulotomy
324:NYHA Class
282:Indications
217:, to treat
99:August 2016
1971:Categories
1874:Cardiac CT
1741:Cardiotomy
1646:Myocardium
1414:Sano shunt
1204:procedures
1202:Tests and
793:(1): 1–8.
616:2018-07-17
580:References
571:Technology
484:phlebogram
211:ventricles
207:electrodes
69:newspapers
1254:and septa
1154:1876-7591
1102:0278-0062
1063:201159537
1005:1099-5129
956:0735-1097
866:1749-8090
850:(1): 47.
807:1923-2829
760:2213-1779
717:22 August
682:1551-7136
564:infection
509:pacemaker
385:ICD only
372:ICD only
369:ICD only
366:ICD only
223:pacemaker
169:eMedicine
1958:Category
1691:minimaze
1687:Cox maze
1162:25440593
1110:28678701
1055:31537334
1013:23385052
983:Europace
964:25190241
884:20525228
825:32095190
768:29598935
690:27371518
515:Benefits
257:axillary
139:ICD-9-CM
1243:Surgery
1118:3871779
875:2898667
816:7011924
298:on the
161:D058409
83:scholar
1930:Pacing
1538:MIDCAB
1529:Bypass
1479:shunt
1373:atrium
1286:mitral
1281:aortic
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420:Method
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404:CRT-D
394:CRT-P
388:CRT-D
375:CRT-P
267:(CS).
215:atrium
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71:
64:
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1887:sound
1759:Tests
1717:S-ICD
1614:Other
1548:TECAB
1393:aorta
1208:heart
1114:S2CID
1059:S2CID
903:(PDF)
272:CRT-D
203:CRT-P
183:[
148:00.54
144:00.51
90:JSTOR
76:books
1689:and
1427:for
1158:PMID
1150:ISSN
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1001:ISSN
960:PMID
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803:ISSN
764:PMID
756:ISSN
719:2022
686:PMID
678:ISSN
641:ISBN
562:and
340:III
155:MeSH
62:news
1836:TEE
1831:TTE
1723:ICD
1518:CHD
1490:SVC
1475:to
1407:to
1391:to
1375:to
1142:doi
1090:doi
1041:doi
991:doi
942:doi
911:doi
870:PMC
852:doi
811:PMC
795:doi
746:doi
670:doi
529:max
343:IV
337:II
292:QRS
259:or
238:QRS
201:or
199:CRT
45:by
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1494:PA
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