Left ventricular lead implantation using the crossover technique in a steeply bifurcated lateral branch

Cardiac resynchronization results in significant clinical improvement in patients with moderate-to-severe heart failure and delayed intraventricular conduction.1 However, the ability to place stable pacing leads in the coronary sinus tributaries for left ventricle (LV) pacing remains a major limiting factor. The high degree of variability in the coronary venous anatomy poses a challenge to implanting electrophysiologists.2