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Background Cardiac resynchronization therapy (CRT) improves outcomes in many heart failure patients, yet 1 in 3 patients do not positively respond. A “U-shaped” left ventricular (LV) activation pattern (type II), suggestive of electrical conduction block, can be characterized by cardiovascular magnetic resonance (CMR) and has been associated with improved CRT response compared to a more homogenous (type I) activation pattern. In other studies, targeting the LV pacing lead to the latest site of LV activation has been associated with improved response. We hypothesized that patients with CMR derived type II ventricular activation pattern and a concordant LV lead placement would have superior CRT response.

Presence of a CMR-based U-shaped contraction pattern and optimal LV pacing lead position determines best response to CRT