Cardiac resynchronization therapy: can left ventricular lead position make the difference?

The authors report the case of an 82-year-old female patient with non-ischemic dilated cardiomyopathy who developed worsening heart failure functional class despite optimal medical therapy. As the patient met criteria for cardiac resynchronization, a CRT-P device was implanted, but due to technical difficulties, the left ventricular lead was implanted in the anterior coronary vein. In the absence of any benefit from the procedure, a new left ventricular lead was implanted in posterolateral position with good clinical and echocardiographic response.