We suggest that placement of an LV lead at the time of open heart surgery, for the purpose of facilitating future CRT, might be considered in patients for whom CRT is recommended and the need for device therapy is unlikely to be changed by the surgical procedure.
(Conditional Recommendation, Low-Quality Evidence)

Values and preferences: This recommendation places value on practical considerations and multidisciplinary discussion in the absence of substantial data.

Practical tip: Patients who have severe structural abnormalities that can be easily corrected with cardiac surgery are the least likely to benefit from LV lead placement. The risk and costs of placing hardware that might be unnecessary needs to be balanced with the feasibility and risk of placing/testing an LV lead at the time of surgery in an eligible patient. As discussed in part 1 of the 2013 Guidelines, an apical LV lead position should be avoided.