Citation: Journal of Cardiovascular Electrophysiology. 2020 Sep 18.Journal: Journal of cardiovascular electrophysiology.Published: ; 2020; FY2021ISSN: 1045-3873.Full author list: Zou F; Brar V; Worley SJ.UI/PMID: 32945053.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal Article | ReviewDigital Object Identifier: https://dx.doi.org/10.1111/jce.14748 (Click here)ORCID: Worley, Seth J http://orcid.org/0000-0003-0462-9386 (Click here)Abbreviated citation: J Cardiovasc Electrophysiol. 2020 Sep 18.Local Holdings: Available online through MWHC library: 2007 -2010, Available in print through MWHC library: 1999 - 2006.Abstract: The essence of cardiac resynchronization therapy (CRT) is biventricular (BiV) pacing, which involves implanting pacing leads in both the right (RV) and left ventricle (LV). Unlike traditional RV pacing, many hurdles lie ahead of successful LV lead implantation. In this review, we first highlight the importance of optimizing the patient and the tools. Next, we describe the CRT tools developed over several decades, to facilitate successful implantation. Thereafter, we provide a streamlined step-by-step summary of the basic BiV implantation procedure. Lastly, we discuss some commonly encountered challenges during implantation and the techniques to tackle them. It is our belief, that a systematic approach to every step of the implantation process can reduce procedure time, decrease patient exposure to radiation and contrast, and minimize complications. Furthermore, we are convinced that the use of right tools and techniques can enable all implanters to become more successful with BiV implantation. This article is protected by copyright. All rights reserved. Copyright This article is protected by copyright. All rights reserved.