Department of Cardiology, Odense University Hospital, Odense, Denmark.
Department of Cardiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Expert Rev Med Devices. 2022 Apr;19(4):341-352. doi: 10.1080/17434440.2022.2075728. Epub 2022 May 17.
Cardiac resynchronization therapy (CRT) is an important option in modern cardiac implantable electronic device (CIED) treatment. Techniques for left ventricular (LV) lead placement in the coronary sinus and its tributaries are neither well described nor studied systematically, despite attention regarding where to place the LV lead.
This review presents specialized tools and techniques to overcome some of the most common problems encountered in LV lead placement in CRT. These tools and techniques are termed Interventional CRT (I-CRT), as they share technology with other interventional procedures. The main principle in I-CRT, compared to the traditional over-the-wire technique, is to add better support for delivery of the LV lead through dedicated inner catheters that also allows more flexibility with the use of more guidewires and better imaging with direct venography in the target vein.
Even though CRT is an established therapeutic option, there are still many challenges in the implementation of the therapy. The cornerstone should be an ease of delivering the CRT and specifically implantation of the LV lead. Therefore, knowledge of the principles in I-CRT is necessary, as I-CRT could make implantation simpler in general and easier to reach the optimal LV pacing site.
心脏再同步治疗（CRT）是现代心脏植入式电子设备（CIED）治疗的重要选择。尽管人们关注左心室（LV）导联的放置位置，但左心室导联在冠状窦及其分支中的放置技术既没有很好的描述，也没有系统地研究。
本综述介绍了专门的工具和技术，以克服 CRT 中 LV 导联放置中遇到的一些最常见的问题。这些工具和技术被称为介入性 CRT（I-CRT），因为它们与其他介入性程序共享技术。与传统的经皮穿刺技术相比，I-CRT 的主要原则是通过专用的内导管提供更好的支持，以输送 LV 导联，同时允许更多的导丝使用和更好的直接静脉造影术的目标静脉成像。
尽管 CRT 是一种成熟的治疗选择，但在实施该治疗方面仍存在许多挑战。基石应该是易于提供 CRT 治疗，特别是植入 LV 导联。因此，了解 I-CRT 的原则是必要的，因为 I-CRT 可以使一般植入更简单，更容易达到最佳的 LV 起搏部位。
