A recent randomized controlled trial (ImagingCRT) conducted at our institution demonstrated that an imaging guided LV lead placement strategy targeting the latest mechanically activated myocardial segment (assessed by pre-implant echocardiography) and separate from scar tissue (determined by pre-implant myocardial scintigraphy) improves clinical response rate to CRT (data not yet published). This method has the potential to become routine clinical practice for LV lead placement at our institution.