Summary

Cardiac resynchronization therapy (CRT) improves mortality and morbidity in heart failure patients with depressed ejection fraction and wide QRS complex, but response varies, with about one third of CRT recipients failing to improve. The Speckle Tracking-Assisted Resynchronization Therapy for Electrode Region trial [STARTER] tested the hypothesis that echo-guided left ventricular (LV) lead placement that targets the site of latest LV mechanical activation is superior to routine positioning for CRT.