77. Three-Dimensional Mapping to Guide Optimal Catheter Position in Cardiac Resynchronization Therapy

  1. Mohammad Shenasa MD2,
  2. Gerhard Hindricks MD3,
  3. Martin Borggrefe MD4,
  4. Günter Breithardt MD5 and
  5. Mark E. Josephson MD6
  1. David Spragg,
  2. Fady Dawoud and
  3. Albert C. Lardo

Published Online: 18 DEC 2012

DOI: 10.1002/9781118481585.ch77

Cardiac Mapping, Fourth Edition

Cardiac Mapping, Fourth Edition

How to Cite

Spragg, D., Dawoud, F. and Lardo, A. C. (2013) Three-Dimensional Mapping to Guide Optimal Catheter Position in Cardiac Resynchronization Therapy, in Cardiac Mapping, Fourth Edition (eds M. Shenasa, G. Hindricks, M. Borggrefe, G. Breithardt and M. E. Josephson), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118481585.ch77

Editor Information

  1. 2

    Attending Physician, Department of Cardiovascular Services, O'Connor Hospital, Heart & Rhythm Medical Group, San Jose, California, USA

  2. 3

    Professor of Medicine (Cardiology), University Leipzig, Heart Center, Director, Department of Electrophysiology, Leipzig, Germany

  3. 4

    Professor of Medicine (Cardiology), Head, Department of Cardiology, Angiology and Pneumology, University Medical Center, Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

  4. 5

    Professor Emeritus of Medicine and Cardiology, Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany

  5. 6

    Chief, Cardiovascular Medicine Division, Director, Harvard-Thorndike Electrophysiology Institute and Arrhythmia Service, Beth Israel Deaconess Medical Center, Herman C. Dana Professor of Medicine, Harvard Medical School, Boston, Massachusetts, USA

Author Information

  1. Division of Cardiology, The Johns Hopkins Hospital, Baltimore, MD, USA

Publication History

  1. Published Online: 18 DEC 2012
  2. Published Print: 10 JAN 2013

ISBN Information

Print ISBN: 9780470670460

Online ISBN: 9781118481585



  • contractile dyssynchrony;
  • cardiac resynchronization therapy;
  • biventricular pacemaker;
  • congestive heart failure;
  • non-ischemic cardiomyopathy;
  • left bundle branch block;
  • surface electrocardiogram;
  • implantable cardioverter-defibrillator platform.


Contractile dyssynchrony due to intraventricular conduction delay diminishes systolic function and is a major independent risk factor for worsening heart failure. Cardiac resynchronization therapy (CRT) is a relatively new treatment that employs a biventricular pacemaker to re-coordinate contraction in ventricles with conduction delay. Although it is highly effective in many patients, approximately 35% do not respond to the therapy. Even when the “right” patient is selected for CRT using inadequate baseline predictors of responsiveness, stimulating the “wrong” left ventricular (LV) site remains an important cause of non-response to CRT. As the underlying disease substrate can vary widely from patient to patient, employing a “one size fits all” strategy has raised skepticism. In this chapter, we review the potential role of mapping both the electrical and mechanical myocardial substrate to enable personalized lead placement for CRT implementation.