Objective CRT has gained acceptance as a useful form of device therapy for patients with refractory congestive heart failure. Despite recent technical advances, some problem still remained unsolved. The study highlighted some of these issues and try to provide possible solutions. Methods Since February 1999, about 50 patients underwent CRT. The CS lead was implanted with PTCA wire for dislodgment of lead in 3 patients. Injury of CS was present in 5 patients. Elevation in left ventricular pacing threshold was found in 2 patients who received early CRT. Results The patients who implanted the CS lead with PTCA wire acquired satisfactory capture threshold without any complication. Pace makers were implanted successfully in all 5 patients with CS injury The CS leads were extracted successfully from the 2 patients with elevated ventricular pacing threstold. Conclusion Implantation of the CS lead is a main step in the operation of CRT and prompt management to its related problems can enhance the operation success rate.

Objective: To conduct a preliminary evaluation for the usability of Carelink remote monitoring system by clinical physician. Methods: A total of 215 patients received cardiovascular implantable electronic devices (CIED) with Carelink remote monitoring function from 12 hospitals in China between 2012-01 and 2013-10 were prospectively enrolled. The patient's mean age was (62.3±14.3) years including 108 male and 107 female. There were 54 physicians completed questionnaire survey. Based on the type of CIED, the patients were divided into3 groups: PM (pace maker) group,n=110, ICD (implantable cardioverter defibrillator) group,n=54 and CRT (cardiac resynchronization therapy) group,n=51. The patients received routine hospital visit at 3 months of CIED implantation and meanwhile, they performed device data transmission at 3 and 6 months of Carelink remote monitoring. The time physician spent to evaluate data was collected at 3 months and the questionnaire survey was completed by physician at 6 months after CIED implantation. Results: All 54 physicians felt that Carelink remote monitoring system was simple to operate and easy to use. There were 147 patients ifnished hospital visit at 3 months after CIED implantation, the mean time for physician to evaluate data was (14.8±8.4) min; 150 patients ifnished Carelink remote monitor at 3 months after CIED implantation, the mean time for physician to evaluate data was (8.2 ±4.6) min,P<0.0001.Conclusion: Carelink remote monitoring system was easy to use, it may save time in follow-up study which with high satisfaction in clinical practice.