Optimizing lead placement for pacing in dyssynchronous heart failure: the patient in the lead.

Abstract Cardiac resynchronisation therapy (CRT) greatly reduces morbidity and mortality in patients with dyssynchronous heart failure. However, despite tremendous effort, response has been variable and can be further improved. Although optimizing left ventricular lead placement (LVLP) is arguably the cornerstone of CRT, the procedure of LVLP using the transvenous approach has remained largely unchanged for over two decades. Improvements have been developed using scar location and electrical and/or mechanical mapping. Moreover, recent interest in conduction system pacing as an alternative to biventricular pacing emerged. Conduction system pacing is promising, but may not be suitable for all patients with dyssynchronous heart failure. This review underscores the importance of a patient-tailored approach and discusses the potential applications of both conduction system pacing and targeted biventricular CRT.