| Sumario: | Introduction: The essence of cardiac resynchronization therapy (CRT) is biventricular (BiV) pacing, which involves implanting pacing leads in both the right ventricle (RV) and left ventricle (LV). Unlike traditional RV pacing, many hurdles lie ahead of successful LV lead implantation. Methods and Results: 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. Conclusion: A systematic approach to every step of the implantation process can reduce procedure time, decrease patient exposure to radiation and contrast, and minimize complications. The use of right tools and techniques can enable all implanters to become more successful with BiV implantation.
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