Targeting Viable Myocardium in Cardiac Resynchronization Therapy Using a Multipolar Left Ventricular Lead

An 81-year-old man with 3-vessel coronary heart disease and a left ventricular (LV) aneurysm, who had been deemed unsuitable for coronary revascularization, was referred for cardiac resynchronization therapy. He was in New York Heart Association class III, and he had a LV ejection fraction of 20% and a left bundle-branch block (QRS duration of 148 ms). Late gadolinium enhancement cardiovascular magnetic resonance showed an apical aneurysm and transmural enhancement in 11 of 17 myocardial segments, including the mid and apical segments of the LV free wall (Figure 1).Figure 1. Steady-state free precession CMR scan showing an apical LV aneurysm, with marked thinning of its walls. The points marked A to D correspond …