Cardiac Resynchronization Therapy with Individualized Placement of Two Left Ventricular Leads at the Sites of Latest Mechanical Left Ventricular Contraction: Guided by 3D-Echocardiography and Coronary Sinus Rotation Angiography

A 78-year-old woman with dilated cardiomyopathy was admitted for advanced dyspnoea and recurrent cardiac decompensation despite optimal medical therapy. Implantation of a cardiac resynchronization therapy (CRT) device was indicated according to current guidelines. The day before CRT implantation, three-dimensional echocardiography was performed together with coronary sinus (CS) rotation angiography, which identified two sites of latest mechanical left ventricular (LV) contraction with adjacently available target veins. This case presents the first description of CRT target vein selection using a combination of functional information on LV contraction with anatomical information on the CS venous tree. In this specific patient, the approach eventually necessitated placement of two LV leads.