A case of coronary venous angioplasty to facilitate left ventricular lead placement

We present a case of cardiac resynchronization therapy (CRT) device implantation, complicated by the presence of a coronary vein stenosis. Although the incidence of coronary venous stenosis is low, ranging from 1% to 4% in a population referred for CRT implantation, it may result in suboptimal LV lead positioning or even abandonment of a transvenous approach and subsequent referral for epicardial LV lead placement. The largest delay in mechanical contraction in a patient with left bundle branch block (LBBB) is often located in the posterolateral region, which is therefore the preferred location for chronic LV pacing.1 Since the long‐term effect of CRT is dependent upon optimal LV lead positioning, additional techniques such as coronary venous angioplasty may be warranted to enable optimal LV lead positioning.