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{\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;13\\\/12\\\/26\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;13\\\/12\\\/26\u0022}],\u0022ac\u0022:{\u0022spmdc;13\\\/12\\\/26\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;13\\\/12\\\/26\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ECardiac resynchronization therapy (CRT) continues to benefit many patients with heart failure (HF), reducing their symptoms and enhancing clinical outcomes and quality of life. This article discusses a series of sessions which covered current perspectives on CRT, including techniques to approach the left ventricle (LV) and optimize lead placement, as well as data from clinical trials that favor the use of triventricular (TriV) pacing. Specific topics include device implantation and optimal lead placement, improving CRT response and optimizing LV site positioning, and the the Dual-Site LV Pacing in CRT Non Responders: Multicenter Randomized Trial [V3; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01059175\u0026amp;atom=%2Fspmdc%2F13%2F12%2F26.atom\u0022\u003ENCT01059175\u003C\/a\u003E; Bordachar P et al. \u003Cem\u003EJ Card Fail\u003C\/em\u003E 2010].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHeart Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ECardiac resynchronization therapy (CRT) continues to benefit many patients with heart failure (HF), reducing their symptoms and enhancing clinical outcomes and quality of life. Jean-Luc Jansens, MD, University of Brussels, Brussels, Belgium, launched a series of sessions which covered current perspectives on CRT, including techniques to approach the left ventricle (LV) and optimize lead placement, as well as data from clinical trials that favor the use of triventricular (TriV) pacing.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EDEVICE IMPLANTATION AND OPTIMAL LEAD PLACEMENT\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EHistorically, attention has been placed on the technical aspects of the procedure, especially LV lead placement which is pivotal for optimal cardiac synchronization. The gold standard technique for device implantation remains the percutaneous approach. However, its disadvantages include implantation failure and inadequate lead positioning, and reliance on the venous anatomy of the heart, which differs between patients.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ESurgery is typically viewed as a back-up procedure for CRT device implantation in cases of percutaneous failure. However, Prof. Jansens remarked that it should also be considered for its ability to improve the CRT response. Robotic surgery in particular is used to optimize LV lead positioning, and implant LV leads for multisite pacing.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EVarious surgical approaches are used for CRT device implantation:\u003C\/p\u003E\n         \u003Cp\u003E\n            \u003C\/p\u003E\u003Cul class=\u0022list-simple \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n                  \u003Cp id=\u0022p-7\u0022\u003E\u25aa Thoracotomy is technically easy, but optimum lead placement is problematic due to difficulty exposing the entire LV\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n                  \u003Cp id=\u0022p-8\u0022\u003E\u25aa Conventional thoracoscopy improves LV exposure, but requires the use of rigid tools to suture a lead onto the beating heart\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n                  \u003Cp id=\u0022p-9\u0022\u003E\u25aa Robotic enhanced thoracoscopy offers improved surgical precision, and is minimally traumatic. However, equipment is expensive, and the learning curve is steep\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\u003Cp\u003E\n         \u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EIMPROVING CRT RESPONSE AND OPTIMIZING LEFT VENTRICLE SITE POSITIONING\u003C\/h2\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EAlthough epicardial leads have a poor reputation in the cardiosurgical field, there is no major evidence against their long-term efficiency. Prof. Jansens noted that they often produce better results than endocardial leads, and in his opinion, steroid-eluting tips represent the best option for epicardial lead implantation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EYet, despite the success of CRT, the nonresponder rate is \u0026gt;30%, and has remained unchanged for many years [Yu CM et al. \u003Cem\u003EJ Cardiovasc Electrophysiol\u003C\/em\u003E 2005]. Since suboptimal LV lead implantation is an important reason for this, effort must be made to improve its positioning, using cardiosurgical tools to facilitate hemodynamic and electroanatomic mapping.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EConventionally, biventricular (BiV) pacing is achieved using one right atrial (RA) lead and one right ventricular (RV) lead, and the LV lead for epicardial pacing is implanted into the coronary sinus. However, we know that LV dyssynchrony typically involves a large area of the heart, so pacing in one epicardial spot may not completely correct dyssynchrony.\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EMultisite pacing of the LV is therefore an option for nonresponders to conventional CRT. Christophe Leclercq, MD, PhD, Rennes University Hospital, Rennes, France, discussed the rationale behind this. Since BiV pacing can result in suboptimal resynchronization, leading to inadequate or no response to CRT, his team designed a clinical trial to compare the effects of TriV with BiV pacing, the Triple Resynchronization in Paced Heart Failure Patients trial [TRIP-HF; Leclercq C et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2008].\u003C\/p\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EThis multicenter study enrolled 40 patients (mean age, 70 years) with moderate to severe HF, and a mean LV ejection fraction (LVEF) of 26%. All patients were in permanent atrial fibrillation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EAfter 3 months of BiV stimulation, patients were randomized to stimulation for 3 months with TriV pacing or conventional BiV pacing. Patients were then crossed over to the alternate configuration for a further 3 months. The primary endpoint of the study was quality of ventricular resynchronization (Z ratio). Secondary endpoints included reverse LV remodeling [Leclerq C et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2008].\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EA significantly increased LVEF (27% vs 35%; p=0.001), decreased LV end-systolic volume (157 vs 134 cm\u003Csup\u003E3\u003C\/sup\u003E; p=0.02), and decreased diameter (57 vs 54 mm; p=0.02) were seen with TriV pacing than with BiV pacing, and the investigators concluded that CRT using TriV pacing was safe, and associated with significantly more LV reverse remodeling than with BiV pacing.\u003C\/p\u003E\n         \u003Cp id=\u0022p-17\u0022\u003EProf. Leclercq then discussed recently published data from the Efficiency Study of Triple-Site Cardiac Resynchronization in Patients With Heart Failure [TRUST CRT; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00814840\u0026amp;atom=%2Fspmdc%2F13%2F12%2F26.atom\u0022\u003ENCT00814840\u003C\/a\u003E; Lenarczyk R et al. \u003Cem\u003EJ Cardiovasc Electrophysiol\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-18\u0022\u003ETRUST CRT was a single-center, prospective study designed to assess implantation feasibility and safety, procedure-related adverse events and lead performance for 12 months in patients included in a trial of CRT using TriV pacing. It enrolled 100 patients (mean age 62 years; 79% male; 61% with ischemic cardiomyopathy; 86% in NYHA Functional Class III) who were randomized to CRT with BiV or TriV pacing.\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EPrimary endpoints included the combined endpoint of alive status, and freedom from hospitalization for HF or heart transplantation. A significant improvement in the rate of responders was seen in the TriV pacing group compared with the BiV pacing group (51% vs 26%; p=0.014; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Lenarczyk R et al. \u003Cem\u003EJ Cardiovasc Electrophysiol\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/12\/26\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Rate of Responders\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1839669450\u0022 data-figure-caption=\u0022Rate of Responders\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/12\/26\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/12\/26\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/12\/26\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13615\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-20\u0022 class=\u0022first-child\u0022\u003ERate of Responders\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-21\u0022\u003EAnd after 12 months, significantly more patients with BiV pacing were in NYHA Functional Class III or IV than those with TriV pacing (30% vs 12.5%; p=0.05; \u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/12\/26\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022NYHA Functional Classification\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1839669450\u0022 data-figure-caption=\u0022NYHA Functional Classification\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/12\/26\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/12\/26\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/12\/26\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13617\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-22\u0022 class=\u0022first-child\u0022\u003ENYHA Functional Classification\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EAdapted from Lenarczyk R et al. \u003Cem\u003EJ Cardiovasc Electrophysiol\u003C\/em\u003E 2013.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-23\u0022\u003EFinally, Prof. Leclercq discussed the Dual-Site LV Pacing in CRT Non Responders: Multicenter Randomized Trial [V3; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01059175\u0026amp;atom=%2Fspmdc%2F13%2F12%2F26.atom\u0022\u003ENCT01059175\u003C\/a\u003E; Bordachar P et al. \u003Cem\u003EJ Card Fail\u003C\/em\u003E 2010].\u003C\/p\u003E\n         \u003Cp id=\u0022p-24\u0022\u003EThis recently completed clinical trial involving 100 patients was designed to determine whether TriV pacing will significantly improve outcomes in nonresponders in terms of clinical and echocardiographic endpoints. The primary endpoint was the comparison of the proportion of patients improved, unchanged, or worsened at 12 months. Although final data are not yet available, Prof. Leclercq stated that there were no reports of failed implantation of the new LV lead.\u003C\/p\u003E\n         \u003Cp id=\u0022p-25\u0022\u003EOverall, he concluded that TriV pacing significantly improves LV reverse remodeling compared with conventional BiV pacing. Although the clinical relevance of TriV pacing requires further evaluation in randomized clinical trials, he hopes emerging data from the V3 trial will provide more insight into its effects in patients who are nonresponders to conventional CRT.\u003C\/p\u003E\n         \u003Cp id=\u0022p-26\u0022\u003EMauro Biffi, MD, University of Bologna, Bologna, Italy, discussed that although LV endocardial pacing has been reported to improve HF status and LV function in case reports or small series due to increased flexibility in LV site selection, it is associated with complications such as thromboembolic disorders.\u003C\/p\u003E\n         \u003Cp id=\u0022p-27\u0022\u003EHe also discussed a guided approach to LV lead placement, including an ongoing pilot study enrolling patients who have failed CRT implantation by a conventional tranvenous approach or patients that have failed to respond to CRT, using a more integrated and individualized approach to therapy. Pivotal to achieving the maximum benefit from LV endocardial stimulation is locating the site of latest mechanical activation by imaging techniques [Doring M. \u003Cem\u003EEuropace\u003C\/em\u003E 2013] or by acute hemodynamic testing [Derval N. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2010]. After locating the site of latest mechanical activation by 3D echocardiography, coronary sinus angiography is used to target the correct vein. Despite the potential to improve responder rate, the procedure requires transesophageal or intracardiac echocardiography assistance, thus resulting in relevant costs compared to conventional CRT implantation.\u003C\/p\u003E\n         \u003Cp id=\u0022p-28\u0022\u003EProf. Biffi summarized by saying that regardless of the technique used to approach the LV, it should target the spot most likely to result in optimal LV mechanical improvement. And additionally, the most important requirement for the advancement of CRT lies in imaging equipment which will allow an individualized approach to LV stimulation.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/12\/26.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznqbe\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznqbe\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}