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We read with great interest the letter by Ze-Zhou Song,1 which raises some important questions with respect to optimizing cardiac resynchronization therapy (CRT). Ze-Zhou Song stated that current lead implantation strategies are mainly guided by anatomic and not by segmental and functional specifications. This implantation technique may be a reason for unpredictable and potentially disappointing effects to CRT. They raise the issue of structurally and functionally inappropriate pacing sites, in particular infarcted, scarred tissue resulting in impaired electrical and functional activity referring to a recent publication by Arzola-Castaner et al.2 This issue is certainly of considerable importance as akinetic, scarred segments are likely to present non-ideal pacing sites. Magnetic resonance imaging to define scarred tissue and the proximity of cardiac veins for potential left ventricular (LV) lead placement has been proposed for preoperative planing of LV lead position.

As proposed by Ze-Zhou Song, we re-evaluated the 28 patients of our study3 with the LV lead position being ‘optimal’, thus close to the latest contracting segment prior to CRT, to define the additional impact of the LV lead position being in an akinetic segment in comparision with being in a non-akinetic segment. No differences between the two subgroups with regard to subsequent improvement in LV function and LV remodelling could be defined. The number of patients in these subgroups may have been too small to detect significant differences. However, we agree that this important issue may need further analysis in the attempt to prevent non-responders to CRT and optimize the CRT effect.

Issue Section:
Letters to the Editor
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