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Background Cardiac resynchronization therapy has been shown to improve exercise capacity and quality of life in cases of inter and intraventicular conduction delay. Several studies have demonstrated that CRT induce a LV reverse remodeling defined by an increase of the EF and a decrease of the end-diastolic diameter. Methods Echocardiographic data were compared retrospectively in 39 patients before and after CRT. The echography were performed in general 1 to 3 months after the implant, then according to the appreciation of the cardiologist (from 1 to 48 months – median 9.5 months). Results The mean EF before implant was 24.7% +/− 6.7 and a LVEDD = 65.2 +/−7.4. At the end of the follow up a significant improvement is noted : EF = 36.1 +/−12 and a LVEDD = 62.8 +/−11. However a significant reverse remodeling is observed in 14 / 39 patients (35,8%). In this specific subgroup, the EF increase from 24 to 47,5 % and the LVEDD decrease from 64.7 to 53 mm. Conclusion Under CRT a significant reverse remodeling seems to be noted in about 35% of the patient and can be delayed or observed very quickly. An independent predictive prognostic factor is needed. [ABSTRACT FROM PUBLISHER]

Persistent left superior vena is a relatively rare congenital variant. It is, however, the most common variation of the thoracic venous system. Prevalence is estimated in about 0.6 to 1.0% during pacemaker placement. This finding, often incidental, can difficult the lead progression through the left jugular or subclavian routes. This report describes a case of successful pacemaker implantation through a persistent left superior vena. Technical difficulties were overcome using the pacemaker electrode as unipolar lead. Endocavitary ECG recording helped us to guide the lead through the tortuous anatomy. A stable lead position was finally achieved by means of the active fixation system of the pacemaker electrode.