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J Interv Card Electrophysiol. 2010 Oct;29(1):17-22. doi: 10.1007/s10840-010-9497-1. Epub 2010 Jun 17.

Assessment of the post-implant final left ventricular lead position: a comparative study between radiographic and angiographic modalities.

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  • 1Cardiac Arrhythmia Service, GRB 109 Massachusetts General Hospital Heart Center, Harvard Medical School, 55 Fruit Street, Boston, MA 02412, USA.



Post-implant lateral and postero-anterior chest X-rays (CXR) are often utilized to determine the final LV lead tip position after cardiac resynchronization therapy (CRT). This study sought to compare post-implant standard CXRs with intra-procedural rotational coronary venous angiography (RCVA) to localize the final LV lead position.


Sixty-four patients undergoing CRT (69.2 ± 11.4 years; males 68.7%; ischemic cardiomyopathy 59.4%; NYHA class 2.9 ± 0.5 and LV ejection fraction 24% ± 9%) were included in the study. RCVA was done by recording a rapid 4-second isocentric cine-loop from RAO 55° to LAO 55° (120 frames). Conventional CXR method (CC) and a composite CXR strategy (CM) based on two-view CXR were separately compared with RCVA.


The most common pacing site was lateral (64.1%), followed by postero-lateral (23.4%) and antero-lateral (10.9%). In 73.4% (47) cases, the LV lead position was misclassified by CC as compared to RCVA. Among the 47 (73.4%) cases misclassified by CC approach, 35 had lateral LV lead position misclassified by CC as postero-lateral (77%), posterior (20%) and antero-lateral (3%). On the other hand, CM strategy classified the LV lead position correctly in 46 (71.9%) of the patients (p < 0.0001).


The composite CXR strategy is a useful method for post-procedure LV lead localization. Due to its simplicity, it can be widely applied in post-implant evaluation of LV lead position in CRT patients.

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