In this issue of the Journal, Giraldi et al. (1) compare transvenous and epicardial lead placement in patients with unfavorable coronary sinus anatomy. Patients who met standard criteria for cardiac resynchronization therapy (CRT) including left ventricular (LV) dysfunction, New York Heart Association class III to IV congestive heart failure, and left bundle branch block, who were on optimal me...

eart failure is the commonest cardiovascular disease that causes high morbidity and mortality. In a selected group of patients with evidence of electrical dyssynchrony, cardiac resynchronization therapy plus defibrillator backup (CRT-D) was established as an important adjunctive therapy. Numerous landmark trials demonstrated that such therapy improved clinical symptoms and quality of life, redu...

ardiac resynchronization therapy (CRT) is an effective reatment for heart failure (HF) for patients who still have ignificant symptoms despite optimal medical therapy. any patients with HF have interventricular and intravenricular conduction delays that cause delayed activation of he lateral wall of the left ventricle (LV). This delayed ctivation leads to ventricular dyssynchrony, which comproi...

Systolic heart failure is a major problem for Americans today, with 550,000 new cases diagnosed per year, and ultimately contributes to 287,000 deaths annually. While pharmacologic therapy has drastically improved outcomes in patients with systolic heart failure, hospitalizations from systolic heart failure continue to increase and remain a major cost burden. In response to this unmet need, rec...