左心室四极导线在心脏再同步治疗中的临床应用

目的：评估左心室四极导线在心脏再同步治疗中的临床应用。方法选择符合心脏再同步治疗（CRT）适应证患者30例,分为左心室四极导线组和双极导线组。比较两组在临床疗效、同步性、手术时间及并发症等方面的差异。结果两组患者左室导线置入时间、手术时间、X 线曝光时间、左室导线位置均无显著差异。四极导线组可选择的起搏向量远多于双极导线组。术后1个月的超声优化程控显示,四极导线组优化后主动脉射血速度时间积分（AOVTI）和左室同步性均显著改善,同时优于双极导线组优化后（P ＜0．05）。随访至术后6个月,四极导线组的左室射血分数优于双极导线组（P ＜0．05）。结论左心室四极导线与双极导线具有同样的安全性,其血液动力学、同步性和短期临床疗效优于双极导线,并可能有助于减少膈神经刺激避免二次手术等并发症。     

超声心动图评估左心室收缩同步性研究的新进展

心室运动的机械不同步在各种类型的心脏病中很普遍,而心脏再同步化治疗可改善同步性。组织多普勒显像、实时三维超声心动图、二维斑点追踪显像和三维超声斑点追踪技术可准确检测左心室的同步性,预测心脏再同步化治疗的效果。超声心动图具有无创伤、操作简便、费用少等优点,是评价左心室机械同步性的主要方法,可部分取代创伤性的心血管造影检查及昂贵的磁共振检查,减少患者的痛苦、减轻患者家属的经济负担,有广阔的临床应用前景。     

组织多普勒和实时三维超声心动图评价心脏再同步化治疗术后的左心室舒张同步性

目的比较组织多普勒成像(TDI)和实时三维超声心动图(RT-3DE)在分析扩张型心肌病(DCM)患者心脏再同步化治疗(CRT)术前及术后6个月左心室舒张早期同步性变化并分析二者间的关系。方法 40例DCM患者均于CRT术前及术后6个月同时行TDI和RT-3DE检查,测定舒张早期二尖瓣频谱峰值与速度峰值之比(E/e’)、舒张早期左心室6节段、12节段、16节段心肌组织速率的舒张峰值时间标准差(Te-SD)。得出左心室6节段、12节段、16节段舒张早期容积的时间标准差(Tedv-SD),标准化后作为舒张早期不同步化指数(DDI),得出左心室射血分数(LVEF);并计算出舒张期峰值充盈率(PFR)、舒张期早期容积与舒张末期容积之比(EDV早/EDV);结果术后6个月LVEF、PFR、EDV早/EDV、E/e’均较CRT术前改善,差异有统计学意义(均P<0.05)。CRT术后1周Te6-SD、Te12-SD、Te16-SD、Tedv6-SD、Tedv12-SD、Tedv16-SD均较术前显著缩短(均P<0.01)。DDI与Te-SD的相关性(r)为0.879(P<0.01),ΔDDI与ΔTe-SD的相关性(r)为0.886(P<0.01)。DDI、Te-SD曲线下面积分别为0.790、0.791(P<0.01),当术前DDI≥8.2%时,能预测CRT疗效,其敏感性和特异性分别为86.3%和100.0%。结论 CRT术后左心室收缩及舒张功能改善,左心室舒张同步性明显改善;TDI与RT-3DE均能评价左心室舒张同步性,2种技术的评价结果具有良好的相关性;DDI对CRT的疗效预测有重要的临床价值。 更多     

超声二维斑点追踪技术评价低钾血症患者左心室同步性的价值

目的 探讨超声二维斑点追踪技术评价低钾血症患者左心室同步性的临床价值.方法 选取2012年1月～2013年6月在我院治疗的低钾血症患者52例：12导联心电图检查QRS时限＞100 ms的32例为观察组;QRS时限≤100 ms且≥60 ms的20例为对照组.观察组和对照组均采用超声二维斑点追踪技术测定其左心室同步化指数（TAS-POST）.超声TAS-POST与心电图QRS时限进行相关性分析.用TAS-POST ＞130 ms作为左心室收缩不同步的判断标准.结果 超声指标评价低钾血症时左心室的同步性明显优于心电图指标,差异有统计学意义（P＜0.05）.结论 超声二维斑点追踪技术能直接观察心肌的机械运动,评价低钾血症时左心室的同步性更为准确、直观、全面,能给临床诊断提供更有利的依据,使患者得到更有效的治疗,值得在临床上大力推广应用.     

心脏再同步治疗中左心室导线的植入体会

目的：探讨心脏再同步化治疗（cardiac resynchronization therapy,CRT）、心脏再同步治疗除颤器（cardiac resynchronization therapy defibrillator,CRT-D）植入过程中左心室导线的植入体会。方法：对51例CRT或CRT-D植入患者左心室导线的植入方法进行分析,对导引鞘深插技术的影响因素、方法及注意事项进行初步探讨。结果：51例中经心内膜成功植入左心室导线48例（94.12%）,采用常规方法（导引鞘引导下直接或单导丝引导下）植入37例（77.08%）,导引鞘深插技术植入9例（18.75%）,双导丝引导及保留导丝技术植入各1例;失败3例（5.88%）,因冠状静脉窦开口异常、靶静脉分支呈锐角及靶血管纤细伴局部狭窄植入失败各1例。结论：在左心室导线植入过程中,充分利用导引鞘深插、双导丝等经皮冠状动脉成形术等相关技术可进一步提高手术成功率,缩短手术时间。     

二维斑点追踪检测的左心室扭转预测心脏再同步化治疗的短期疗效

 目的探讨超声二维斑点追踪（STE）检测的左心室扭转参数预测心脏再同步化治疗（CRT）短期疗效的价值。方法接受CRT治疗的心衰患者34例,在术前3 d及术后1个月采用STE检测左心室基底和心尖峰值旋转角度（Rot-Ba 和Rot-Ap）、基底和心尖达峰值旋转角度时间（T-Ba 和T-Ap）、基底和心尖达峰时间差（Ba-Ap Rot Delay）、左心室峰值扭转角度（Ptw）和达峰时间（TPtw）、左心室标化峰值扭转角度（Ptor）。将术后左室收缩末容积（LVESV）减小率△LVESV≥15%定义为CRT短期治疗有效。结果21 例（61.8%）患者为CRT 短期治疗有效组（R 组）。术前R 组Rot-Ba、Rot-Ap、Ptw 和Ptor 大于无效组（NR 组）,Ba-Ap
Rot Delay 短于NR 组,其余参数无差异。术后与NR组比较,R 组的Rot-Ba、Rot-Ap、Ptw 和Ptor 增大,Ba-Ap Rot Delay 缩短。Rot-Ap、Ptw 和Ptor 是△LVESV≥15%的独立影响因素,Ptw跃2.2毅预测CRT 短期治疗有效的敏感性和特异性分别为78%和74%。结论STE 检测的左心室扭转参数可准确预测CRT 短期疗效。     

实时三维超声心动图及二维斑点追踪成像技术评估预激综合征患者左心室收缩同步性

目的:应用实时三维超声心动图(RT-3DE)及二维斑点追踪成像(2D-STI)技术评估预激综合征患者左心室收缩同步性临床应用价值。方法:选取芜湖市第二人民医院预激综合征患者35例为病例组,选取同期健康体检者35例为正常对照组。应用2D-STI计算左心室17节段圆周应变达峰时间标准差(Tcs-SD)、纵向应变达峰时间标准差(Tls-SD)、圆周应变率达峰时间标准差(Tcsr-SD)、纵向应变率达峰时间标准差(Tlsr-SD)参数水平值。应用RT-3DE记录左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)、左心室射血分数(LVEF);分析17节段左心室容积-时间曲线(VTC),选取16节段最小收缩末容积时间差的标准差(Tmsv16-SD)、16节段最小收缩末容积时间差的最大时间差(Tmsv16-Dif)、校正后的16节段最小收缩末容积时间标准差(Tmsv16-SD%)、校正后的16节段最小收缩末容积时间最大时间差(Tmsv16-Dif%)进行同步记录分析。结果:(1)病例组Tcs-SD、Tls-SD、Tcsr-SD、Tlsr-SD均高于对照组(P<0.001)。(2)病...     

2D-STI联合RT-3DE评价右心室间隔部起搏器植入术前后左心室收缩功能及同步性的临床研究

目的:联合运用二维斑点追踪技术(Two-dimensional speckle tracking imaging,2D-STI)及实时三维超声心动图(Real-time three-dimensional echocardiography,RT-3DE)评估右心室间隔部(RVS)起搏器植入术前、术后左心室功能及同步性,...     

斑点追踪技术联合三维超声心动图评估冠心病患者PCI术后左心室心肌功能和同步性临床研究

目的:应用二维斑点追踪技术(Two-dimensional speckle tracking imaging,2D-STI)和三维超声心动图(Real-time three-dimensional echocardiography,RT-3DE)对前降支冠状动脉狭窄的冠心病患者PCI术后进行左心室心肌功能和同步性的临床...     

二维斑点追踪技术联合实时三维超声心动图评价下壁、后壁心肌梗死患者左心室收缩功能及同步性

目的: 联合应用二维斑点追踪技术(two-dimensional speckle tracking imaging, 2DSTI)与实时三维超声心动图(real time three dimensional echocardiography, RT 3DE)评价下壁、后壁心肌梗死患者左心室收缩功能与同步性。方法: 对20例下壁、后壁心肌梗死患者（心肌梗死组）及健康对照组20例行常规超声心动图检查,获得左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）、左心室射血分数（LVEF）;同时存储心尖四腔心观、二腔心观、左室长轴观及二尖瓣水平、乳头肌水平、心尖水平左室短轴观的足够帧频二维图像。采用Qlab 9.0软件分析收缩期峰值纵向应变及圆周应变。采用RT 3DE获取左心室全容积图像,用Qlab 9.0软件获得左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、每搏输出量（SV）及射血分数(EF3d),并分析左心室16节段达收缩期最小容积点时间的标准差(Tmsv16-SD)及最大时间差(Tmsv16 Dif),并对标准差及时间差进行心率校正。结果： 两种方法测得的LVEF值心肌梗死组明显小于健康对照组(P<0.05),LVEDD、LVESD、LVESV明显大于健康对照组(P<0.05),SV明显小于健康对照组(P<0.05);心肌梗死组下壁、后壁对应节段及相邻的部分节段纵向应变及圆周应变均比健康对照组明显降低（P<0.05）;心肌梗死患者Tmsv16-SD校正值和Tmsv16 Dif校正值均明显大于健康对照组（P<0.01）。结论： 2DSTI和RT 3DE能更加准确无创地判断下壁、后壁心肌梗死患者的节段性室壁运动异常及不同步性。     

Utility of echocardiographic tissue synchronization imaging to redirect left ventricular epicardial lead placement for cardiac resynchronization therapy

Background Cardiac resynchronization therapy （CRT） with biventricular pacing has demonstrated cardiac function improvement for treating congestive heart failure （HF）. It has been documented that the placement of the left ventricular lead at the longest contraction delay segment has the optimal CRT benefit, This study described follow-up to surgical techniques for CRT as a viable alternative for patients with heart failure. Methods Between April 2007 and June 2012, a total of 14 consecutive heart failure patients with New York Heart Association （NYHA） Class Ill-IV underwent left ventricular epicardial lead placements via surgical approach. There were eight males and six females, aged 36 to 79 years （（59.6±9.2） years）. The mean left ventricular ejection fraction （LVEF） was （33.6±7.4）%. All patients were treated with left ventricular systolic dyssynchrony and underwent left ventricular epicardial lead placements via a surgical approach. Tissue Doppler imaging （TDI） and intraoperative transesophageal echocardiography were used to assess changes in left heart function and dyssynchronic parameters. Also, echo was used to select the best site for left ventricular epicardial lead placement. Results Left ventricular epicardial leads were successfully implanted in the posterior or lateral epicardial wall without serious complications in all patients. All patients had reduction in NYHA score from Ⅲ-Ⅳ preoperatively to Ⅱ-Ⅲ postoperatively. The left ventricular end-diastolic diameter （LVEDD） decreased from （67.9±12.7） mm to （61.2±7.1） mm （P〈0.05）, and LVEF increased from （33.6±7.4）% to （42.2±8.8）% （P〈0.05）. Left ventricular intraventricular dyssynchrony index decreased from （148.4±31.6） ms to （57.3±23.8） ms （P〈0.05）. Conclusions Minimally invasive surgical placement of the left ventricular epicardial lead is feasible, safe, and efficient. TDI can guide the epicardial lead placement to the ideal tar qet location.     

Assessment of left ventricular systolic synchronicity by real-time three-dimensional echocardiography in patients with dilated cardiomyopathy

Background Recent advances in real-time three-dimensional echocardiography (RT3DE) offer the potential to assess the left ventricular (LV) dyssynchrony simultaneously by analyzing the 17 segments time-volume curves. The purpose of this study was to test the feasibility and accuracy of RT3DE for quantitative evaluation of left ventricular systolic synchronicity.Methods Twenty-four patients with dilated cardiomyopathy (DCM) and twenty-five healthy volunteers were enrolled in this study. Full volume RT3DE was performed by using Philips IE33 with X3-1 probe. The global and 17-segmental time-volume curves were obtained by the on-line Qlab software (version 4.2). The time to minimal systolic volume in each segment (T(msv)) was taken to derive the following indexes of systolic asynchrony: T(msv) 16-SD, T(msv) 16-Dif, T(msv) 12-SD, T(msv) 12-Dif, T(msv) 6-SD and T(msv) 6-Dif, which meant the standard deviation or the maximal difference of T(msv) among the 16, 12 and 6 segments of the left ventricle respectively. The software also provided with each of the above parameters as a percentage of the cardiac cycle. Results T(msv) 16-SD, T(msv) 12-SD and T(msv) 6-SD were all significantly larger in the DCM group than those of the control group [T(msv) 16-SD: (52.9±40.6) ms vs (8.8±6.2) ms; T(msv) 12-SD: (29.5±30.8) ms vs (6.9±4.0) ms; T(msv) 6-SD: (28.9±34.6) ms vs (7.0±4.7) ms, all P≤0.001]. T(msv) 16-Dif, T(msv) 12-Dif and T(msv) 6-Dif were also significantly larger in the DCM group. There were close negative relations between the LVEF determined by RT3DE and each of the indexes of systolic asynchrony, among which the indexes of T(msv)-16-SD% and T(msv)-16-Dif% correlated most closely (r=－0.703 and r =－0.701, respectively). The DCM patients had significantly larger EDV and ESV, with significantly reduced LVEF compared with the healthy subjects. Conclusion RT3DE provides a simple, useful and unique approach to assess the systolic synchronicity of all the left ventricular segments simultaneously.     

Echocardiographic mapping of left ventricular resynchronization during cardiac resynchronization therapy procedures

Background Cardiac resynchronization therapy （CRT） is an effective electrical therapy for patients with moderate to severe heart failure and cardiac dyssynchrony. This study aimed to investigate the degree of acute left ventricular （LV） resynchronization with biventricular pacing （BVP） at different LV sites and to examine the feasibility of performing transthoracic echocardiography （TTE） to quantify acute LV resynchronization during CRT procedure. Methods Fourteen patients with NYHA Class Ⅲ-Ⅳ heart failure, LV ejection fraction 〈35%, QRS duration 〉120 ms and septal-lateral delay （SLD） 〉60 ms on tissue Doppler imaging （TDI）, underwent CRT implant. TDI was obtained from three apical views during BVP at each accessible LV site and SLD during BVP was derived. Synchronicity gain index （Sg） by SLD was defined as （I＋（SLD at baseline - SLD at BVP）/SLD at baseline）. Results Seventy-two sites were studied. Positive resynchronization （R＋, Sg〉1） was found in 42 （58%） sites. R＋ was more likely in posterior or lateral than anterior LV sites （66% vs. 36%, P 〈0.001）. Concordance of empirical LV lead implantation sites and sites with R＋ was 50% （7/14）. Conclusions The degree of acute LV resynchronizaUon by BVP depends on LV lead location and empirical implantation of LV lead results in only 50% concordance with R＋. Performing l-rE during CRT implantation is feasible to identify LV sites with positive resynchronization.     

实时三维超声成像及斑点追踪评价冠状动脉再通术前后左心室功能变化

目的 探讨实时三维超声成像（real-time three-dimensional echocardiography,RT3DE）及二维斑点追踪显像（two dimensional speckle tracking imaging,2DSTI）评价冠状动脉慢性完全闭塞（coronary artery chronic total occlusions,CA CTOs）患者经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）术前后的左心室功能变化情况.方法 选择2012年1月-2013年12月在辽宁医学院附属第一医院收治的40例CA CTOs患者,分别于术前及术后1个月接受标准超声心动图检查,应用RT3DE和2DSTI对左心室射血分数（left ventricular ejection fraction,LVEF）、左心室舒张末期容积（left ventricular end-diastolic volume,LVEDV）、左心室收缩末期容积（left ventricular end-systolic volume,LVESV）、收缩不同步指数（systolic dyssynchrony index,SDI）及左心室整体纵向应变（left ventricular global longitudinal strain,LVGLS）进行测量分析,并与30例健康志愿者进行比较.结果 与PCI术前比较,术后1个月LVEF显著增加（P＜0.05）,LVEDV和LVESV显著下降（P均＜0.05）,SDI也显著下降（P＜0.05）,LVGLS显著增加（P＜0.05）;与对照组比较,各参数指标仍未达到正常水平（P＜0.05）.LVGLS的增加与LVEF增加呈正相关（r=0.27,P=0.02）.结论 RT3DE的LVEDV、LVESV、SDI及2DSTI的LVGLS能较好地评价CA CTOs患者PCI术后左心室功能的恢复情况,提示左心室功能明显改善.     

Validation of real-time three-dimensional echocardiography for quantifying left and right ventricular volumes: an experimental study

Background Assessment of the left ventricular (LV) and the right ventricular (RV) volumes and their functions is important for prognostic prediction and clinical decision making. We compared the accuracy for quantifying the LV and the RV volumes in vitro between conventional two-dimensional echocardiography (2DE) and real-time three-dimensional echocardiography (RT3DE). Methods The volumes of 37 rubber-models (10 regularly shaped to simulate normal LV, 7 shaped to simulate LV with symmetric aneurysm, 8 shaped to simulate LV with asymmetric aneurysm, and 12 irregularly shaped to simulate normal RV) and 10 excised canine hearts were measured by RT3DE and 2DE. On RT3DE “full volume” imaging, the inner-surfaces of the rubber-models and canine LV and RV were outlined and the volumes were measured using 2-, 4-, 8- and 16-plane methods with the RT3DE analysis software. On 2DE imaging, the volumes were measured by the Simpson method. The LV and RV volumes measured by drained water were served as reference values, with which we compared RT3DE and 2DE data.Results In rubber models mimicking normal LV and LV with symmetric aneurysms, RT3DE results were strongly correlated with reference values (r=0.795-0.998) and there was a good correlation between 2DE estimates and reference values (r=0.715-0.729). There were no significant differences between RT3DE estimates, 2DE results and reference values (P&gt;0.05). In rubber models mimicking the RV and LV with asymmetric aneurysm, RT3DE strongly correlated with reference values (r=0.765-0.988), but 2DE weakly correlated with reference values (r=0.518-0.592). There were no differences between RT3DE and reference values (P&gt;0.05), but a significant difference between 2DE and reference values occurred (P&lt;0.05). For excised canine hearts, there was a strong correlation between RT3DE and reference values (r=0.728-0.914), while 2DE showed a less obvious correlation (r=0.502-0.615). Again, there were no significant differences between RT3DE and reference values (P&gt;0.05), but there was a significant difference between 2DE and reference values (P&lt;0.05).Conclusions RT3DE can accurately quantify LV and RV volumes and provides a new tool to evaluate LV and RV function. For LV and RV measurements by RT3DE, 8-plane strategy is the optimum choice for accuracy and convenience.     

RT-3DE与2D-STI评价二尖瓣置换术前后左心房功能的临床价值

目的 应用实时三维超声心动图（RT-3DE）和二维斑点追踪显像技术（2D-STI）评价二尖瓣置换术（mitral valve replacement,MVR）前、后左心房功能的变化及其临床价值.方法 2010年11月-2014年1月在我院住院并拟行二尖瓣置换术的患者40例分别于术前、术后3个月及术后1年进行超声心动图检查,应用RT-3DE测量左心房舒张末容积（LAVmax）、左心房收缩末容积（LAVmin）、左心房收缩前容积（LAVp）、左心房被动射血分数（LAEFp）、左心房主动射血分数（LAEFa）,计算左心房整体射血分数（LAEF）.应用2D-STI测量左心房前壁、后壁、侧壁、下壁及房间隔的应变及应变率.将2D-STI与RT-3DE测得的左心房功能相关指标进行比较,并与40例正常对照组进行比较.结果 STI测得MVR术前左心房应变（Ss）及各时期应变率（mSRs、mSRe、mSRa）均小于正常对照组,术后3个月Ss、mSRs、mSRe较术前低,术后1年左心房Ss、mSRs、mSRe比术前和术后3个月高,但仍低于正常对照组（P＜0.05）.RT-3DE测得MVR术前、术后左心房各容积（LAVmaxLAVmin、LAVp）大于正常对照组,LAEF、LAEFp、LAEFa小于正常对照组（P＜0.05）;MVR术后3个月LAEF、LAEFp较术前降低（P＜0.05）.术后1年左心房LAEF、LAEFp高于术前及术后3个月,但仍低于正常对照组（P＜0.05）.正常对照组、MVR术前、术后3个月、术后1年mSRe与LAEFp呈正相关（r=0.915、0.874、0.813、0.43,P＜0.05）,mSRa与LAEFa呈正相关（r=0.792、0.769、0.705、0.689,P＜0.05）.结论 RT-3DE和2D-STI对二尖瓣置换术疗效的评估具有一定临床价值.     

二维斑点追踪成像与定量组织速度成像评价心功能不全患者左室扭转运动

目的应用二维斑点追踪成像(2D-STI)与定量组织速度成像(QTVI)技术评价心功能不全患者左室扭转运动特征,对比分析两种方法在评价心功能不全中的应用价值。方法收集30例心功能不全患者(心功能不全组)和30例健康志愿者(正常对照组)的左室心底水平(MV)及心尖水平(AP)标准短轴图像。应用2D-STI测量各水平峰值旋转角度(Pr)、收缩末峰值旋转角度(AVC-r),计算左室扭转角度(LVtw)、收缩末左室扭转角度(AVC-LVtw)。应用QTVI测量各水平侧壁及后间隔切线方向运动速度,并得出该水平收缩期侧壁间隔位移差(SDl-s),计算左室扭转运动指数(TMI)。由同一观察者于不同时间反复测量上述参数,计算两种方法的观察者内变异系数。结果①正常对照组的收缩期旋转及扭转运动特征:从心尖向心底方向观察,MV顺时针旋转,AP逆时针旋转,左室逆时针扭转,LVtw为(14.57±3.06)°,TMI为11.80±1.16;②心功能不全组MV旋转方向与正常对照组一致,部分病例AP旋转方向及左室扭转方向发生变化。心功能不全组Pr、LVtw、SDl-s及TMI均明显减低,差异有统计学意义(P<0.05);③2D-STI技术在评价心功能不全方面较为稳定可靠,QTVI较为简捷直观。结论 2D-STI与QTVI技术均可用于评价心功能不全患者的左室旋转及扭转运动,2D-STI较为稳定可靠,QTVI较为简捷直观。     

Use of the Attain Select Ⅱ catheter delivery system to improve left ventricular lead implantation in cardiac resynchronization therapy

Background Despite technical advances in tools used to facilitate implantation of cardiac resynchronization therapy (CRT) devices, there are many hurdles related mainly to the variation in the anatomy of the coronary veins. One such difficulty is the presence of a very sharply-angulated or tortuous of the lateral or posterolateral cardiac vein.Methods Totally 44 patients, 28 males and 16 females, with congestive heart failure and intraventricular conduction delay were studied retrospectively. There were 23 patients who had left ventricular (LV) lead implantation using standard techniques and equipment. For the other 21 patients with LV lead implantation we used the Attain Select Ⅱ catheter delivery system. The patients were seen every 3-6 months for 12 months and the efficacy of the primary procedure, LV lead implantation time, procedure and fluoroscopy time and the complications associated with the two techniques were evaluated.Results There were no significant differences in the age, gender, New York Heart Association (NYHA) functional class,ischemic etiology, QRS duration, left ventricular ejection fraction, left ventricular end-diastolic diameter, left ventricular end-systolic diameter and LV dyssynchrony between the two groups. The LV lead implantation time, procedure time and fluoroscopy time were significantly shorter in the group using the Attain Select Ⅱ catheter delivery system; LV lead implantation time from (51-7) minutes to (40±7) minutes (P ＜0.001), procedure time from (143±17) minutes to (124±18)minutes (P=0.001), and fluoroscopy time from (45±7) minutes to (35±6) minutes (P＜0.001). A successful procedure of LV lead implantation was significantly improved from 17/23 (74%) patients using the standard techniques and equipment, to 20/21 (95.3%) patients using the Attain Select Ⅱ catheter delivery system (P=0.06)Conclusion It is feasible and safe to implant LV leads through the coronary sinus using the Attain Select Ⅱ catheter delivery system.