As per the literature, patients with intraventricular conduction delay (IVCD) do not respond well to cardiac resynchronization therapy (CRT) alone. They need advanced technological approach and out of the box thinking for a good response. Ours is a case of ischemic cardiomyopathy with wide QRS-IVCD, a non-responder to CRT. While planning for replacement of the device for early replacement indicator (ERI), we decided to do His-optimized CRT/left bundle optimized CRT (HOT-CRT/LOT-CRT) for the patient. The challenges we faced with the present available hardware paved a way for insisting on the limitation of the available lumenless lead to penetrate calcified the septum and importance of the pre-procedure evaluation of intraventricular septum (IVS) for calcification by more than just echocardiography.

中文翻译：

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生理起搏以改善心脏再同步治疗无反应者和钙化性隔a的try石-病例报告

根据文献，仅进行心室内传导延迟（IVCD）的患者对心脏再同步治疗（CRT）的反应并不好。他们需要先进的技术方法和开箱即用的思维才能获得良好的响应。我们的病例是缺血性心肌病，伴有广泛的QRS-IVCD，对CRT无反应。在计划更换早期诊断指示器（ERI）的设备时，我们决定为患者进行His优化的CRT /左束优化的CRT（HOT-CRT / LOT-CRT）。我们目前可用的硬件所面临的挑战为坚持可用的无内腔铅穿透的局限性铺平了道路，这不仅是超声心动图，而且还强调了对室间隔（IVS）进行钙化的术前评估对钙化的重要性。