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Cardiac resynchronization therapy (CRT) restores the synchrony of the heart’s  contractions. The most critical issue in CRT implantation is the positioning  of the coronary sinus (CS) lead because not every region can be accessed due  to variations in coronary venous anatomy. The aim was to determine the  correlation between different CS lead positions and hemodynamic changes and  clinical outcome over time. Our study prospectively enrolled 51 patients with  conventional indications for CRT which was divided into three groups  according to the vein in which the left ventricle lead was placed during the  procedure (posterior, lateral, and anterior). The groups were compared by  baseline demographic characteristics, comorbidity, complications, new  hospitalizations as well as by hemodynamic parameters before and six months  after the procedure. After six months, all patients responded to CRT in the  lateral group, 66.7% patients in the posterior group and 50% in the anterior  group (p<0.01). Patients in the anterior group had a smaller decrease in NYHA  functional class compared to the posterior and the lateral groups (p<0.01).  The largest increase of preoperative ejection fraction value was in the  posterior group (68.7%) compared to the lateral (42.2%) and anterior groups  (19.8%) (p<0.01, A vs. P&L; P vs. A&L). In the anterior group there was a  smaller decrease of QRS complex compared to the posterior and lateral groups  (p< 0.05, A vs. P&L). Also there was a smaller decrease in the degree of  mitral regurgitation in the anterior group compared to the lateral and  posterior groups (p<0.05, A vs. P&L). One of the main determinants of CRT  response is the anatomy of CS tributaries, and therefore the position of the  LV lead is crucial in maximizing the effect of CRT

Is cardiac venous anatomy a crucial factor in maximizing the response to cardiac resynchronisation therapy?